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A+ Verified 2025-2026 Pediatric Nursing Proctored Exam |
140 NCLEX & ATI Practice Questions with Detailed
Rationales — Guaranteed to Pass
Question 1
A nurse is assessing a 4-year-old child who is scheduled for a tonsillectomy. The
parent expresses concern about the child being afraid of the hospital. Which is the
most appropriate action for the nurse to take to prepare the child for the procedure?
A. Explain the surgery using complex medical terms
B. Provide a picture book and allow the child to role-play with medical equipment
C. Avoid discussing the procedure to prevent fear
D. Schedule a preoperative class for adults only
Correct Answer: B
Rationale: Preschool-aged children benefit from play therapy and concrete
explanations. Allowing them to role-play with safe medical equipment (such as a
toy stethoscope) reduces anxiety and helps them understand the procedure.
Avoiding discussion can increase fear, and medical jargon is not developmentally
appropriate.
Question 2
A nurse is caring for a toddler admitted with dehydration due to gastroenteritis.
Which finding should the nurse expect?
A. Bradycardia
B. Sunken anterior fontanel
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C. Increased tear production
D. Weight gain
Correct Answer: B
Rationale: A sunken anterior fontanel is a classic sign of dehydration in infants
and toddlers. Dehydration also causes dry mucous membranes, decreased tear
production, and weight loss, not weight gain. Bradycardia is not an expected
finding; tachycardia is more common.
Question 3
A nurse is providing teaching to the parents of a 6-month-old about introducing
solid foods. Which statement by the parent indicates understanding?
A. "I will start with pureed fruits and wait 3 days between new foods."
B. "I can give honey as long as it’s in small amounts."
C. "I should add cow’s milk to the baby’s diet right away."
D. "I can start solid foods at 2 months."
Correct Answer: A
Rationale: Solid foods should be introduced at around 6 months, starting with
single-ingredient purees. Waiting 3–5 days between new foods allows for
observation of allergic reactions. Honey should be avoided until after 12 months
due to botulism risk. Cow’s milk is not recommended before age 1 due to poor
digestibility and lack of necessary nutrients.
Question 4
A nurse is caring for a school-age child with sickle cell anemia admitted for a vaso-
occlusive crisis. Which is the priority nursing intervention?
A. Encourage ambulation
B. Apply cold compresses to painful areas
C. Administer prescribed opioid analgesics
D. Restrict oral fluids
Correct Answer: C
Rationale: Pain control is the priority in a vaso-occlusive crisis, as severe pain can
lead to increased metabolic demand and further sickling. Heat, not cold, helps
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improve blood flow. Adequate hydration is essential to prevent further sickling, so
fluids should not be restricted.
Question 5
A nurse is assessing a 2-year-old with suspected otitis media. Which finding
supports the diagnosis?
A. Bright red tympanic membrane with no movement on pneumatic otoscopy
B. Clear fluid visible behind the tympanic membrane
C. White patches on the tonsils
D. Pain when palpating the tragus
Correct Answer: A
Rationale: Otitis media often presents with a red, bulging tympanic membrane and
limited mobility. Clear fluid suggests serous otitis media, which is non-infectious.
White tonsillar patches indicate pharyngitis or tonsillitis. Tragus tenderness is
associated with otitis externa, not otitis media.
Question 6
A nurse is providing anticipatory guidance to the parents of a 10-year-old. Which
activity is appropriate for this developmental stage?
A. Parallel play with peers
B. Competitive board games
C. Imitative play
D. Solitary play
Correct Answer: B
Rationale: School-age children enjoy competitive activities and rules-based
games, which foster social skills and cooperation. Parallel play is typical for
toddlers, imitative play for preschoolers, and solitary play for infants.
Question 7
A nurse is teaching the parents of an infant with gastroesophageal reflux (GER).
Which statement by the parent indicates a need for further teaching?
A. "I will thicken my baby’s formula with rice cereal."
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B. "I will keep my baby upright for 30 minutes after feeding."
C. "I will place my baby in a prone position for sleep to prevent reflux."
D. "I will feed my baby smaller, more frequent meals."
Correct Answer: C
Rationale: Infants should always be placed on their backs to sleep to reduce the
risk of SIDS, even with GER. Thicker formula, upright positioning after feeding,
and small frequent meals are appropriate interventions.
Question 8
A nurse is caring for a child with acute lymphoblastic leukemia who is receiving
chemotherapy. Which action is most important?
A. Encourage large crowds to visit for emotional support
B. Monitor for petechiae and unusual bleeding
C. Provide high-fiber foods to prevent constipation
D. Administer live vaccines as scheduled
Correct Answer: B
Rationale: Children receiving chemotherapy are at high risk for bleeding due to
bone marrow suppression. Monitoring for bleeding is essential. Large crowds
should be avoided due to infection risk, and live vaccines are contraindicated
during immunosuppression.
Question 9
A nurse is assessing a 7-year-old with suspected appendicitis. Which finding
requires immediate intervention?
A. Low-grade fever
B. Abdominal pain in the right lower quadrant
C. Sudden relief of pain followed by abdominal rigidity
D. Nausea and vomiting
Correct Answer: C
Rationale: Sudden relief of pain followed by rigidity may indicate perforation,
which is a medical emergency. Appendicitis typically presents with RLQ pain,
fever, and nausea, but perforation increases the risk for peritonitis.
A+ Verified 2025-2026 Pediatric Nursing Proctored Exam |
140 NCLEX & ATI Practice Questions with Detailed
Rationales — Guaranteed to Pass
Question 1
A nurse is assessing a 4-year-old child who is scheduled for a tonsillectomy. The
parent expresses concern about the child being afraid of the hospital. Which is the
most appropriate action for the nurse to take to prepare the child for the procedure?
A. Explain the surgery using complex medical terms
B. Provide a picture book and allow the child to role-play with medical equipment
C. Avoid discussing the procedure to prevent fear
D. Schedule a preoperative class for adults only
Correct Answer: B
Rationale: Preschool-aged children benefit from play therapy and concrete
explanations. Allowing them to role-play with safe medical equipment (such as a
toy stethoscope) reduces anxiety and helps them understand the procedure.
Avoiding discussion can increase fear, and medical jargon is not developmentally
appropriate.
Question 2
A nurse is caring for a toddler admitted with dehydration due to gastroenteritis.
Which finding should the nurse expect?
A. Bradycardia
B. Sunken anterior fontanel
,2
C. Increased tear production
D. Weight gain
Correct Answer: B
Rationale: A sunken anterior fontanel is a classic sign of dehydration in infants
and toddlers. Dehydration also causes dry mucous membranes, decreased tear
production, and weight loss, not weight gain. Bradycardia is not an expected
finding; tachycardia is more common.
Question 3
A nurse is providing teaching to the parents of a 6-month-old about introducing
solid foods. Which statement by the parent indicates understanding?
A. "I will start with pureed fruits and wait 3 days between new foods."
B. "I can give honey as long as it’s in small amounts."
C. "I should add cow’s milk to the baby’s diet right away."
D. "I can start solid foods at 2 months."
Correct Answer: A
Rationale: Solid foods should be introduced at around 6 months, starting with
single-ingredient purees. Waiting 3–5 days between new foods allows for
observation of allergic reactions. Honey should be avoided until after 12 months
due to botulism risk. Cow’s milk is not recommended before age 1 due to poor
digestibility and lack of necessary nutrients.
Question 4
A nurse is caring for a school-age child with sickle cell anemia admitted for a vaso-
occlusive crisis. Which is the priority nursing intervention?
A. Encourage ambulation
B. Apply cold compresses to painful areas
C. Administer prescribed opioid analgesics
D. Restrict oral fluids
Correct Answer: C
Rationale: Pain control is the priority in a vaso-occlusive crisis, as severe pain can
lead to increased metabolic demand and further sickling. Heat, not cold, helps
,3
improve blood flow. Adequate hydration is essential to prevent further sickling, so
fluids should not be restricted.
Question 5
A nurse is assessing a 2-year-old with suspected otitis media. Which finding
supports the diagnosis?
A. Bright red tympanic membrane with no movement on pneumatic otoscopy
B. Clear fluid visible behind the tympanic membrane
C. White patches on the tonsils
D. Pain when palpating the tragus
Correct Answer: A
Rationale: Otitis media often presents with a red, bulging tympanic membrane and
limited mobility. Clear fluid suggests serous otitis media, which is non-infectious.
White tonsillar patches indicate pharyngitis or tonsillitis. Tragus tenderness is
associated with otitis externa, not otitis media.
Question 6
A nurse is providing anticipatory guidance to the parents of a 10-year-old. Which
activity is appropriate for this developmental stage?
A. Parallel play with peers
B. Competitive board games
C. Imitative play
D. Solitary play
Correct Answer: B
Rationale: School-age children enjoy competitive activities and rules-based
games, which foster social skills and cooperation. Parallel play is typical for
toddlers, imitative play for preschoolers, and solitary play for infants.
Question 7
A nurse is teaching the parents of an infant with gastroesophageal reflux (GER).
Which statement by the parent indicates a need for further teaching?
A. "I will thicken my baby’s formula with rice cereal."
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B. "I will keep my baby upright for 30 minutes after feeding."
C. "I will place my baby in a prone position for sleep to prevent reflux."
D. "I will feed my baby smaller, more frequent meals."
Correct Answer: C
Rationale: Infants should always be placed on their backs to sleep to reduce the
risk of SIDS, even with GER. Thicker formula, upright positioning after feeding,
and small frequent meals are appropriate interventions.
Question 8
A nurse is caring for a child with acute lymphoblastic leukemia who is receiving
chemotherapy. Which action is most important?
A. Encourage large crowds to visit for emotional support
B. Monitor for petechiae and unusual bleeding
C. Provide high-fiber foods to prevent constipation
D. Administer live vaccines as scheduled
Correct Answer: B
Rationale: Children receiving chemotherapy are at high risk for bleeding due to
bone marrow suppression. Monitoring for bleeding is essential. Large crowds
should be avoided due to infection risk, and live vaccines are contraindicated
during immunosuppression.
Question 9
A nurse is assessing a 7-year-old with suspected appendicitis. Which finding
requires immediate intervention?
A. Low-grade fever
B. Abdominal pain in the right lower quadrant
C. Sudden relief of pain followed by abdominal rigidity
D. Nausea and vomiting
Correct Answer: C
Rationale: Sudden relief of pain followed by rigidity may indicate perforation,
which is a medical emergency. Appendicitis typically presents with RLQ pain,
fever, and nausea, but perforation increases the risk for peritonitis.
