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2025-2026 NCLEX Pediatric Nursing Question Bank
(160 Qs) | Wong’s Essentials of Pediatric Nursing, 12th
Edition Practice Test with Rationales
1. A nurse is caring for a patient with heart failure who is receiving
furosemide. Which assessment finding requires the nurse’s immediate
attention?
A. Weight loss of 2 pounds in 2 days
B. Urine output of 1,200 mL/day
C. Serum potassium level of 2.9 mEq/L
D. Mild complaints of thirst
Correct Answer: C. Serum potassium level of 2.9 mEq/L
Rationale: A serum potassium level of 2.9 mEq/L is a critical electrolyte
imbalance that poses a high risk for cardiac dysrhythmias, especially in
patients with heart failure. Furosemide is a loop diuretic that promotes the
loss of potassium through the urine. Hypokalemia at this level can lead to
muscle weakness, ventricular arrhythmias, and potentially cardiac arrest if
not corrected promptly. While weight loss, adequate urine output, and thirst
are important to monitor, none present an immediate life-threatening risk
like a severely low potassium level.
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2. Which assessment data is most important to monitor in a patient
receiving nitroglycerin infusion for chest pain?
A. Respiratory rate
B. Heart rate
C. Blood pressure
D. Oxygen saturation
Correct Answer: C. Blood pressure
Rationale: The most important parameter to monitor during a nitroglycerin
infusion is the patient’s blood pressure. Nitroglycerin causes vasodilation,
which can lead to significant hypotension if not carefully titrated. A sudden
drop in blood pressure can result in decreased perfusion to vital organs and
syncope. Although heart rate and oxygen saturation are important, they are
secondary to the primary concern of blood pressure control when
administering this potent vasodilator.
3. The nurse is assessing a patient with acute pericarditis. Which clinical
finding should the nurse report to the provider immediately?
A. Pericardial friction rub
B. Chest pain that worsens when lying down
C. Jugular vein distension and hypotension
D. Fever and elevated white blood cell count
Correct Answer: C. Jugular vein distension and hypotension
Rationale: Jugular vein distension accompanied by hypotension suggests
the development of cardiac tamponade, a life-threatening complication of
pericarditis. This condition occurs when fluid accumulates in the pericardial
sac, compressing the heart and impairing its ability to pump effectively.
While a pericardial friction rub, positional chest pain, and fever are expected
in pericarditis, the presence of hypotension and JVD requires immediate
intervention, often pericardiocentesis.
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4. A patient with a history of coronary artery disease reports new-onset
chest pain that is unrelieved by rest. What is the nurse’s priority action?
A. Administer prescribed antacids
B. Place the patient in a high Fowler’s position
C. Notify the rapid response team
D. Administer sublingual nitroglycerin
Correct Answer: D. Administer sublingual nitroglycerin
Rationale: In a patient with known coronary artery disease experiencing
chest pain unrelieved by rest, the first priority is to reduce myocardial
oxygen demand and improve perfusion by administering sublingual
nitroglycerin. This medication dilates coronary arteries and reduces preload,
potentially relieving ischemia. High Fowler’s positioning may help
breathing, and notifying the rapid response team may be necessary later if
symptoms persist or worsen, but the immediate nursing action is to give
nitroglycerin as prescribed.
5. A nurse is reviewing the ECG of a patient admitted with an acute
myocardial infarction. Which finding is most concerning?
A. ST elevation in leads II, III, and aVF
B. Inverted T waves in lead V1
C. Sinus bradycardia at 58 bpm
D. Occasional premature ventricular contractions
Correct Answer: A. ST elevation in leads II, III, and aVF
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, which may be associated with right ventricular
infarction and can lead to serious complications such as bradycardia,
hypotension, and cardiogenic shock. It is a medical emergency requiring
immediate intervention, often including reperfusion therapy. In contrast, T
wave inversions and occasional PVCs may be expected post-MI and sinus
bradycardia at this rate is not usually life-threatening.
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11. A nurse is caring for a patient with atrial fibrillation who is
scheduled for cardioversion. What is the nurse’s priority assessment
before the procedure?
A. Blood glucose level
B. Serum electrolyte levels
C. INR or anticoagulation status
D. Presence of pedal pulses
Correct Answer: C. INR or anticoagulation status
Rationale: Before performing synchronized cardioversion on a patient with
atrial fibrillation, it is critical to assess the patient’s anticoagulation status.
Atrial fibrillation increases the risk for thrombus formation in the atria, and
electrical cardioversion can dislodge a clot, causing a stroke. Ensuring a
therapeutic INR (if on warfarin) or confirming appropriate anticoagulation
reduces this risk. Other assessments are important, but they are not the
immediate priority related to the safety of cardioversion.
12. A patient with aortic stenosis is scheduled for surgery. Which
preoperative finding should be reported immediately to the surgeon?
A. Bruising on the arms
B. Hemoglobin level of 12.1 g/dL
C. New onset of chest pain and syncope
D. Blood pressure of 136/82 mmHg
Correct Answer: C. New onset of chest pain and syncope
Rationale: In a patient with aortic stenosis, new chest pain and syncope
suggest worsening obstruction of the aortic valve and potential myocardial
ischemia. This finding is critical and must be communicated to the surgeon,
as it may influence surgical timing and preoperative preparation. Bruising
and hemoglobin of 12.1 g/dL are not immediately concerning, and the blood
pressure is within normal limits.
2025-2026 NCLEX Pediatric Nursing Question Bank
(160 Qs) | Wong’s Essentials of Pediatric Nursing, 12th
Edition Practice Test with Rationales
1. A nurse is caring for a patient with heart failure who is receiving
furosemide. Which assessment finding requires the nurse’s immediate
attention?
A. Weight loss of 2 pounds in 2 days
B. Urine output of 1,200 mL/day
C. Serum potassium level of 2.9 mEq/L
D. Mild complaints of thirst
Correct Answer: C. Serum potassium level of 2.9 mEq/L
Rationale: A serum potassium level of 2.9 mEq/L is a critical electrolyte
imbalance that poses a high risk for cardiac dysrhythmias, especially in
patients with heart failure. Furosemide is a loop diuretic that promotes the
loss of potassium through the urine. Hypokalemia at this level can lead to
muscle weakness, ventricular arrhythmias, and potentially cardiac arrest if
not corrected promptly. While weight loss, adequate urine output, and thirst
are important to monitor, none present an immediate life-threatening risk
like a severely low potassium level.
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2. Which assessment data is most important to monitor in a patient
receiving nitroglycerin infusion for chest pain?
A. Respiratory rate
B. Heart rate
C. Blood pressure
D. Oxygen saturation
Correct Answer: C. Blood pressure
Rationale: The most important parameter to monitor during a nitroglycerin
infusion is the patient’s blood pressure. Nitroglycerin causes vasodilation,
which can lead to significant hypotension if not carefully titrated. A sudden
drop in blood pressure can result in decreased perfusion to vital organs and
syncope. Although heart rate and oxygen saturation are important, they are
secondary to the primary concern of blood pressure control when
administering this potent vasodilator.
3. The nurse is assessing a patient with acute pericarditis. Which clinical
finding should the nurse report to the provider immediately?
A. Pericardial friction rub
B. Chest pain that worsens when lying down
C. Jugular vein distension and hypotension
D. Fever and elevated white blood cell count
Correct Answer: C. Jugular vein distension and hypotension
Rationale: Jugular vein distension accompanied by hypotension suggests
the development of cardiac tamponade, a life-threatening complication of
pericarditis. This condition occurs when fluid accumulates in the pericardial
sac, compressing the heart and impairing its ability to pump effectively.
While a pericardial friction rub, positional chest pain, and fever are expected
in pericarditis, the presence of hypotension and JVD requires immediate
intervention, often pericardiocentesis.
, 3
4. A patient with a history of coronary artery disease reports new-onset
chest pain that is unrelieved by rest. What is the nurse’s priority action?
A. Administer prescribed antacids
B. Place the patient in a high Fowler’s position
C. Notify the rapid response team
D. Administer sublingual nitroglycerin
Correct Answer: D. Administer sublingual nitroglycerin
Rationale: In a patient with known coronary artery disease experiencing
chest pain unrelieved by rest, the first priority is to reduce myocardial
oxygen demand and improve perfusion by administering sublingual
nitroglycerin. This medication dilates coronary arteries and reduces preload,
potentially relieving ischemia. High Fowler’s positioning may help
breathing, and notifying the rapid response team may be necessary later if
symptoms persist or worsen, but the immediate nursing action is to give
nitroglycerin as prescribed.
5. A nurse is reviewing the ECG of a patient admitted with an acute
myocardial infarction. Which finding is most concerning?
A. ST elevation in leads II, III, and aVF
B. Inverted T waves in lead V1
C. Sinus bradycardia at 58 bpm
D. Occasional premature ventricular contractions
Correct Answer: A. ST elevation in leads II, III, and aVF
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, which may be associated with right ventricular
infarction and can lead to serious complications such as bradycardia,
hypotension, and cardiogenic shock. It is a medical emergency requiring
immediate intervention, often including reperfusion therapy. In contrast, T
wave inversions and occasional PVCs may be expected post-MI and sinus
bradycardia at this rate is not usually life-threatening.
, 4
11. A nurse is caring for a patient with atrial fibrillation who is
scheduled for cardioversion. What is the nurse’s priority assessment
before the procedure?
A. Blood glucose level
B. Serum electrolyte levels
C. INR or anticoagulation status
D. Presence of pedal pulses
Correct Answer: C. INR or anticoagulation status
Rationale: Before performing synchronized cardioversion on a patient with
atrial fibrillation, it is critical to assess the patient’s anticoagulation status.
Atrial fibrillation increases the risk for thrombus formation in the atria, and
electrical cardioversion can dislodge a clot, causing a stroke. Ensuring a
therapeutic INR (if on warfarin) or confirming appropriate anticoagulation
reduces this risk. Other assessments are important, but they are not the
immediate priority related to the safety of cardioversion.
12. A patient with aortic stenosis is scheduled for surgery. Which
preoperative finding should be reported immediately to the surgeon?
A. Bruising on the arms
B. Hemoglobin level of 12.1 g/dL
C. New onset of chest pain and syncope
D. Blood pressure of 136/82 mmHg
Correct Answer: C. New onset of chest pain and syncope
Rationale: In a patient with aortic stenosis, new chest pain and syncope
suggest worsening obstruction of the aortic valve and potential myocardial
ischemia. This finding is critical and must be communicated to the surgeon,
as it may influence surgical timing and preoperative preparation. Bruising
and hemoglobin of 12.1 g/dL are not immediately concerning, and the blood
pressure is within normal limits.
