Comprehensive Pediatric Clinical Assessment Practice Exam (2025–2026): High-Accuracy Revie, Exercises of Pediatrics

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Hesiology Practice

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Question 1 The nurse is assessing a 2-year-old. What behavior indicates that the child's language development is within normal limits? Correct Answer Half of child's speech is understandable. Rationale: Between approximately 15 and 24 months of age, a child's speech is only half understandable. A child can begin counting and name colors usually between 3 and 5 years of age. And a child is capable of two - four word sentences between 18 months to 24 months of age. Question 2 As part of the physical assessment of children, the nurse observes and palpates the fontanels. Which child's fontanel finding should be reported to the healthcare provider? Correct Answer A 6-month-old with failure to thrive that has a closed anterior fontanel. Rationale: At six months of age the anterior fontanel should be open, and it should not be closed until approximately 18 months of age. Premature closure of the fontanels is a condition called "craniosynostosis". The only treatment for this condition is surgery to reopen the fontanels, to allow and accommodate the infant's growing brain, otherwise if not surgical corrected, the infant will suffer severe neurological damage. Question 3 The nurse must prevent a 2-year-old with severe eczema on the face, neck, and scalp from scratching the affected areas. Which nursing intervention is most effective in preventing further excoriation due to the Question 4 The nurse observes a 4-year-old boy in a daycare setting. Which behavior should the nurse consider normal for this child? Question 5 The clinic nurse is taking the history for a new 6-month-old client. The mother reports that she took a great deal of aspirin while pregnant. Which assessment should the nurse obtain? Correct Answer Four-year- old children are aggressive in their behavior and enjoy "tale telling" Rationale: Demonstrates aggressiveness by boasting when telling a story. Correct Answer inhibit use of the hands for play activities. Elbow restraints prevent arm flexion and the ability to reach to scratch the involved areas, but do not Rationale : Place elbow restraints on the child's arms. Correct Answer pruritis ?

Rationale: Pepto Bismol, Bismylate contains subsalicylate and if used in the presence of a viral illness, there is the potential of developing Reye's syndrome, a sometimes fatal condition for children. Question 10 At 8 a.m. the unlicensed assistive personnel (UAP) informs the charge nurse that a female adolescent client with acute glomerulonephritis has a blood pressure of 210/110. The 4 a.m. blood pressure reading was 170/88. The client reports to the UAP that she is upset because her boyfriend did not visit last night. What action should the nurse take first? Question 11 What preoperative nursing intervention should be included in the plan of care for an infant with pyloric stenosis? Correct Answer Observe for projectile vomiting. Rationale: In pyloric stenosis, the valve between stomach and small intestine enlarges blocking the passage of food. The nurse needs to ensure suctioning equipment is closed by to help prevent aspiration from the projectile vomiting episodes and monitor for the state of metabolic alkalosis, which is a classic sign of pyloric stenosis. Question 12 The nurse is teaching a 12-year-old male adolescent and his family about taking injections of growth hormone for idiopathic hypopituitarism. Which adverse symptoms, commonly associated with growth hormone therapy, should the nurse plan to describe to the child and his family? Question 13 Which finding in a 19-year-old female client should trigger further assessment by the nurse? Correct Answer Menstruation has not occurred. Rationale: interventio ns. administered first because it lowers the blood pressure very quickly, before implementing any of the other After the nurse has verified the client's elevated blood pressure, the sublingual Procardia should be Rational e: Administer PRN prescription of nifedipine (Procardia) sublingually. Correct Answer hormones should be monitored to detect elevated blood sugars and glucose intolerance. Signs and symptoms of diabetes or hyperglycemia need to be reported. Clients who are receiving growth Rational e: Polyuria and polydipsia. Correct Answer

Menstruation is an expected secondary sex characteristic that occurs with pubescence and typically occurs between the ages of 10 to 17, so the fact the client is 18 years old and has not experience menarche, should prompt further investigation to determine the cause of this primary amenorrhea. Question 14 During administration of a blood transfusion, a child complains of chills, headache, and nausea. Which action should the nurse implement? Question 15 The nurse is assessing a 13-year-old girl with suspected hyperthyroidism. Which question is most important for the nurse to ask her during the admission interview? Correct Answer "Are you experiencing any type of nervousness?" Rationale: Assessing the client's psychophysiologic state upon admission is a priority, and nervousness, apprehension, hyperexcitability, and palpitations are signs of hyperthyroidism. Weight loss (even with a hearty appetite) occurs in those with hyperthyroidism, but assessing the client's neurological state has a higher priority. Question 16 A child is rescued from a burning house and brought to the emergency room with partial- thickness burns on the face and chest. Which action should the nurse implemented first? Correct Answer Question 17 The mother of a 4-year-old child asks the nurse what she can do to help her other children cope with their sibling's repeated hospitalizations. Which is the best response that the nurse should offer? Correct Answer with factual information and contact with the ill child, so sibling visitation should be encouraged. Children Siblings of a sick child will often be scared, concerned or confused. Needs of a sibling will be better met Rational e: Encourage the mother to have the children visit the hospitalized sibling. stopped immediately and the healthcare provider notified. The child is exhibiting signs of a reaction to the blood transfusion. The blood transfusion should be Rationale : Stop the infusion immediately and notify the healthcare provider. Correct Answer place the child at risk for smoke inhalation injury and compromised airway. Assessing the airway and the respiratory status is the highest priority since burns to the face and chest Rationale : Assess the child's respiratory status.

A 2-year-old child with Down syndrome is brought to the clinic for his regular physical examination. The nurse knows which problem is frequently associated with Down syndrome? Correct Answer Congenital heart disease. Rationale: Congenital heart disease is the most common associated defect in children with Down syndrome. Clients with trisomy 21 are diagnosed with Down Syndrome. Clients affected by trisomy 13 are affected by a syndrome called "Patau's Syndrome" and clients with trisomy 18 are affected by a syndrome called "Edward's Syndrome". All three of these trisomy syndromes have some form of congenital cardiac anomalies present with these chromosomal defects. Question 23 The nurse assigning care for a 5-year-old child with otitis media is concerned about the child's increasing temperature over the past 24 hours. Which statement is accurate and should be considered when planning care for the remainder of the shift? Correct Answer Tympanic and oral temperatures are equally accurate. Rationale: A tympanic membrane sensor approximates core temperatures because the hypothalamus and eardrum are perfused by the same circulation. Tympanic readings obtained using proper technique correlated moderately to strongly with oral temperatures in recent research studies. The sensor is unaffected by cerumen or the presence of suppurative or unsuppurative otitis media. Question 24 The vital signs of a 4-year-old child with polyuria are: BP 80/40, Pulse 118, and Respirations 24. The child's pedal pulses are present with a volume of +1, and no edema is observed. What action should the nurse implement first? Correct Answer Start an IV infusion of normal saline. Rationale: The current blood pressure reading of 80/40 mmHg and the decreased peripheral pulse volume indicates that the child is experiencing fluid volume deficit due to the polyuria, so the priority action is to restore fluid volume. Normal range for blood pressure levels for 3- year olds according to the American Heart Association and the American Academy of Pediatrics if 104-116/63-74 mmHg dependent on the height and weight of the child. The other vital signs for the child are considered within normal limits; normal heart rate for a 3- 4 year old at rest while awake is (80-120 beats per minute) and respirations for a 3-6 year old is (22-34 respirations per minute). Question 25 An 18-month-old is admitted to the hospital with possible Hirschsprung's disease. When obtaining a nursing history, the nurse asks about bowel habits. What description of the disease? Correct Answer Ribbonlike and brown. Rationale:

Hirschsprung's disease is a mechanical obstruction caused by inadequate motility in a part of the intestines. The condition results from failure of ganglion cells to migrate craniocaudally along the GI tract during gestation. The lack of peristalsis in the affected bowel segment causes constipation and small diameter, brown-colored stools. Foul-smelling and fatty stool is associated with cystic fibrosis. Bile-colored and watery stool is common in gastroenteritis. Semi-solid and yellow stool is normal in breastfed neonates. Question 26 In developing a teaching plan for a 5-year-old child with diabetes, which component of diabetic management should the nurse plan for the child to manage first? Question 27 The nurse is assigning care for a 4-year-old child with otitis media and is concerned about the child's increasing temperature over the past 24 hours. When planning care for this child, it is important for the nurse to consider that Correct Answer a tympanic measurement of temperature will provide the most accurate reading. Rationale: A tympanic membrane sensor is an excellent site because both the eardrum and hypothalamus (temperature-regulating center) are perfused by the same circulation. The sensor is unaffected by cerumen and the presence of suppurative or unsuppurative otitis media does not effect measurement. RULE OF THUMB: for management--sterile procedures should be assigned to licensed personnel. Management skills will be tested on the NCLEX! Rectal temperature measurement is less accurate because of the possibility of stool in the rectum. Question 28 A 6-month-old boy and his mother are at the healthcare provider's office for a well-baby check-up and routine immunizations. The healthcare provider recommends to the mother that the child receive an influenza vaccine. What medications should the nurse plan to administer today? Correct Answer All the immunizations with the influenza vaccine given at a separate site from any other injection. Rationale: At 6-months of age, the routine immunizations include Hepatitis B, DTaP, Hib (Haemophilus influenza type b) , PCV (Pneumococcal), IPV (inactivated poliovirus) and influenza. To ensure the infant receives the influenza vaccine, it should be given that same visit, at a separate site from any other injection site. Question 29 A 15-year-old girl tells the school nurse that all of her friends have started their periods and she feels abnormal because she has not. Which response is best for the nurse provide? Correct Answer the number (it is especially helpful if the nurse presents this activity as a game). old has the cognitive and psychomotor skills to use a glucometer and to read yea - r Developmentally, a - 5 Rationale : Process of glucose testing. Correct Answer

Question 31 The nurse is assessing a 2-year-old child. What behavior indicates that the child's language development is within normal limits? Question 32 The parents of a 3-week-old infant report that the child eats well but, vomits after each feeding. What information is most important for the nurse to obtain? Question 33 Which class of antiinfective drugs is contraindicated for use in children under 8 years of age? Question 34 Which behavior would the nurse expect a two-year-old child to exhibit? Correct Answer Question 35 The nurse is developing a plan of care for a 3-year-old who is scheduled for a cardiac catheterization. To assist in decreasing anxiety for the child on the day of the procedure, which intervention is best for the nurse to implement? Correct Answer Give the child a ride on a gurney to visit the cardiac catheterization lab and meet a nurse who works there. Rationale: Question 36 sentence s. Normal language skills within the toddler development period is the ability of making two to three word Rational e: Is capable of making a three word sentence. Correct Answer which may be helpful in developing a plan of care for this infant. A description of the vomiting episodes will assist the nurse in determining the reason for the symptoms, Rational e: Description of vomiting episodes in past 24 hours. Correct Answer Tetracyclines cause enamel hypoplasia and tooth discoloration in children under 8 years of age. Rationale: Tetracyclines . Correct Answer "parallel" play where they will play alongside with others, but not with others. old children are egocentric and unable to share with other children. Toddlers demonstrate yea - r Two - Rationale : Display possessiveness of toys.

During discharge teaching of a child with juvenile rheumatoid arthritis, the nurse should stress to the parents the importance of obtaining which diagnostic testing? Correct Answer Eye exams. Rationale: Visual changes leading to blindness can occur in children with juvenile idiopathic arthritis (JIA). The most common eye problem for clients with JIA is uveitis which can lead to glaucoma, cataracts, and permanent visual damage. These complications can be prevented if detected early, so it is important the parents are educated about the importance of eye exams for their child diagnosed wit JIA. Question 37 The nurse is preparing a health teaching program for parents of toddlers and preschoolers and plans to include information about prevention of accidental poisonings. It is most important for the nurse to include which instruction? Question 38 A 4-year-old girl continues to interrupt her mother during a routine clinic visit. The mother appears irritated with the child and asks the nurse, "Is this normal behavior for a child this age?" The nurse's response should be based on which information? Correct Answer Children need to retain a sense of initiative without impinging on the rights and privileges of others. Rationale: Children aged 3 to 6 are in Erickson's "Initiative vs. Guilt" stage, which is characterized by vigorous, intrusive behavior, enterprise, and strong imagination. At this age, children develop a conscience and must learn to retain a sense of initiative without impinging on the rights of others. Question 39 The nurse is caring for a 12-year-old with Syndrome of Inappropriate Antidiuretic Hormone (SIADH). This child should be carefully assessed for which complication? Question 40 A 2-year-old child with gastro-esophageal reflux has developed a fear of eating. What instruction should the nurse include in the parents' teaching plan? Correct Answer Consistently follow a set mealtime routine. Rationale: more anxiety than the child). there prior to the procedure day should help decrease anxiety of the child and mother (who may have Familiarizing the child and mother with the department by visiting the cath lab and meeting the personnel them out of reach of children in locked cabinets. The only reliable way to prevent poisonings in young children is to make them inaccessible by storing Rationale : Store all toxic agents and medicines in locked cabinets. Correct Answer

Correct Answer A trial of human chorionic gonadotrophic hormone. Rationale: A trial of HCG (human chorionic gonadotrophic hormone) may aid in testicular descent, but does not replace surgical repair for true undescended testes. Undescended testes (cryptorchidism) may be found in the inguinal canal due to exaggerated cremasteric reflex. Question 45 During routine screening at a school clinic, an otoscope examination of a child's ear reveals a tympanic membrane that is pearly gray, slightly bulging, and not movable. What action should the nurse take next? Correct Answer Ask the child if he/she has had a cold, runny nose, or any ear pain lately. Rationale: More information is needed to interpret these findings. The tympanic membrane is normally pearly gray, not bulging, and moves when the client blows against resistance or a small puff of air is blown into the ear canal. Since this child's findings are not completely normal, further assessment of history and related signs and symptoms is indicated for accurate interpretation of the findings. Question 46 The nurse receives a lab report stating a child with asthma has a theophylline level of 15 mcg/dl. What action will the nurse take? Question 47 The nurse reviews the latest laboratory results for a child who received chemotherapy last week and identifies a reduced neutrophil count. Which nursing diagnosis has the highest priority for this child? Question 48 A 17-year-old male student reports to the school clinic one morning for a scheduled health exam. He tells the nurse that he just finished football practice and is on his way to class. The nurse assesses his vital signs: temperature 100 F, pulse 80, respirations 20, and blood pressure 122/82. What is the best action for the nurse to take? Correct Answer This information evaluates the prescribed therapy and should be communicated in the nurse's report. The therapeutic level of theophylline is 10 to 20 mcg/dl, so the child's level is within the therapeutic range. Rational e: Pass the information on in the report. Correct Answer

Tell the student to proceed directly to his regularly scheduled class. Rationale: This student has just completed football practice, and increased muscle activity increases body heat production. A temperature of 100 F is normal for this student at this time. The student should attend class since no further nursing action is required. Question 49 A 14-year-old female client tells the nurse that she is concerned about the acne she has recently developed. Which recommendation should the nurse provide? Correct Answer Wash the hair and skin frequently with soap and hot water. Rationale: Washing the hair and skin with soap and hot water removes oil and debris from the skin and helps prevent and treat acne. Oily skin is especially bothersome during adolescence when hormones cause enlargement of sebaceous glands and increased glandular secretions which predispose the teenager to acne. Removing all blackheads and following with an alcohol scrub is contraindicated. The use of medicated cosmetics to help hide the blemishes should be used sparingly to avoid further blocking sebaceous gland ducts. A visit with the dermatologist may be encouraged if healthcare recommendations are not successful. Question 50 Which menu selection by a child with celiac disease indicates to the nurse that the child understands Question 51 A child with cystic fibrosis is having stools that float and are foul smelling. Which descriptive term should the nurse use to document the finding? Correct Answer Steatorrhea. Rationale: Steatorrhea is defined as stools with an abnormally high fat content that are usually foul smelling and float on water. Cystic fibrosis is an autosomal recessive gene condition that affects the secretory glands and can affect many parts of the body. The digestion system is affected by blockage of the glands involved in digestion such as the pancreas and gall the priority nursing diagnosis at this time. Chemotherapy (CT) suppresses phagocytotic neutrophils and places the child at risk for infection, which is Rational e: Risk for infection. Correct Answer should avoid any products containing these ingredients to avoid symptoms such as diarrhea. Celiac disease causes an intolerance to the protein gluten found in oats, rye, wheat, and barley. The child Rational e: baked potato chips and cola. Ove - n Correct Answer necessary dietary considerations?

Correct Answer Question 58 All of the following interventions can be used to evaluate the effectiveness of nursing and medical interventions used to treat diarrhea. Which intervention is least useful in the nurse's evaluation of a Question 59 A 3-week-old newborn is brought to the clinic for follow-up after a home birth. The mother reports that her child bottle feeds for 5 minutes only and then falls asleep. The nurse auscultates a loud murmur characteristic of a ventricular septal defect (VSD), and finds the newborn is acyanotic with a respiratory rate of 64 breaths per minute. What instruction should the nurse provide the mother to ensure the infant is receiving adequate intake? (Select all that apply.) Correct Answer 1.Monitor the the infant's weight and number of wet diapers per day. 2.Increase the infant's intake per feeding by 1 to 2 ounces per week. 3.Allow the infant to rest and refeed on demand or every 2 hours. 4.Use a softer nipple or increase the size of the nipple opening. Rationale: Neonates who have VSD may fatigue quickly during feeding and ingest inadequate amounts. They should be monitored for weight gain and at least 6 wet diapers per day. A and is characterized by abdominal pain and anemia. The findings support a sequestration crisis, where blood pools in the spleen and sometimes in the liver, Rational e: Sequestratio n. Correct Answer Cyanosis indicates impaired circulation to fingers and should be reported immediately. Rationale: "Call the healthcare provider immediately if his nail beds appear blue." Correct Answer priority? experiencing an asthma exacerbation. Intercostal retractions result from respiratory effort to draw air into restricted airways when a child is Rationale : inspiration . fontanel closed by 18 months of age. the fontanels would not be appropriate. The posterior fontanel should be closed at 2 months and anterior All of these interventions are used to evaluate fluid status in infants, but with a 20 month old, assessing Rational e: Assessing fontanels. Correct Answer old child? mont - h

one-month old infant should ingest 2 to 4 ounces (60-120mL) of formula per feeding and progress to about 30 ounces (900mL) per day by 4months of age. Due to fatigue, the infant should rest, but feed at least every 2 hours to ensure adequate intake. A softer (preemie) nipple or a larger slit in the nipple helps to reduce the sucking effort and energy expenditure, thus allowing the infant to ingest more with less effort. Antibiotic prophylaxis is recommended for infants with VSDs, but should not be mixed in a bottle of formula because it is difficult to ensure that the total dose is consumed. Question 60 The nurse is teaching a mother to give 4 ml of a liquid antibiotic to a 10-month-old infant. Which statement by the parent indicates a need for further teaching? Correct Answer "Using a teaspoon will help me measure this correctly." Rationale: The prescribed medication is 4 ml per dosage and is measured with the most accuracy using an oral syringe, so if the parent uses a teaspoon, which is equivalent to 5 ml, further teaching is indicated. Question 61 A three-month old boy weighing 10 lbs 15 oz has an axillary temperature of 98.9 F. The nurse determines the daily caloric need for this child is approximately Correct Answer 600 calories per day. Rationale: 10 lbs 15 oz = 10.9 lbs. Convert lbs to kg by dividing pounds by 2.2; 10.9/2.2 = 4.954 kg, rounded to 5 kg. An infant requires 108 calories/kg/day (108 x 5 = 540 calories/day). However, this infant requires 10% more calories because he has one degree temperature elevation. 10% of 540 is 54 and 540 + 54 = 594. This infant will require approximately 600 calories/day. Question 62 Which restraint should be used for a toddler after a cleft palate repair? Correct Answer Question 63 A hospitalized 16-year-old male refuses all visits from his classmates because he is concerned about his distorted appearance. To increase the client's social interaction, what intervention is best for the nurse to initiate? Correct Answer Arrange for an Internet connection in the client's room for email communication. Rationale: site . Elbow restraints prevent children from bending their arms and bringing their hands to the oral surgical Rationale : Elbow .

Correct Answer Question 68 The mother of a 2-year-old boy consults the nurse about her son's increased temper tantrums. The mother states, "Yesterday he threw a fit in the grocery store, and I did not know what to do. I was so embarrassed. What can I do if this occurs again?" Which recommendation is best for the nurse to provide this mother? Correct Answer Walk away from him and ignore the behavior. Rationale: The best approach for a toddler's inappropriate behavior is to ignore the attention-seeking behavior. The parent should be somewhat nearby, within view of the child, but should avoid reinforcing the behavior in any way. Tantrums can sometimes be avoided by talking to the child before the situation occurs. Question 69 A six-month-old returns from surgery with elbow restraints in place. What nursing care should be included when caring for any restrained child? Question 70 A premature newborn girl, born 24 hours ago, is diagnosed with a patent ductus arteriosus (PDA) and placed under an oxygen hood at 35%. The parents visit the nursery and ask to hold her. Which response should the nurse provide to the parents? Correct Answer "The oxygen hood is holding the baby's oxygen level just at the point which is needed. You may stroke and talk to her." Rationale: The baby is at 35% FiO2 which is much more than room air (21% FIO2) and at this time the baby should not be moved from under the oxyhood. The nurse should offer the parents an alternative such as to stroke the infant and talking to the baby. The baby should recognize the parent's voices because at 5 months gestation in utero, the sense of hearing is developed. Even though, holding sick babies is beneficial and recommended for the infant and the parents, the infant's need for oxygenation has a higher priority at this time. fluids . Regardless of a client's age, adequate renal function must be present before adding potassium to IV Rationale : Serum BUN and creatinine levels. done . and should not be kept in restraints at all times and skin assessments and neurovascular checks should be Removing restraints one at a time is safer than removing all of both at once. The child needs to exercise Rational e: Remove restraints one at a time and provide range of motion exercises. Correct Answer

Question 71 A female teenager is taking oral tetracycline HCL (Achromycin V) for acne vulgaris. What is the most important instruction for the nurse to include in this client's teaching plan? Correct Answer "Use sunscreen when lying by the pool." Rationale: Photosensitivity is a common side effect of tetracycline HCL (Achromycin V) therapy. Severe sunburn can occur with minimal sun exposure and clients should be instructed to avoid sunlight and to use sunscreen. Question 72 A 3-year-old boy is brought to the emergency room because he swallowed an entire bottle of children's vitamin pills. Which intervention should the nurse implement first? Correct Answer Determine the child's pulse and respirations. Rationale: The most important principle in dealing with a poisoning is to treat the child first, not the poison. Initiate immediate life support measures with assessment of vital signs, in particular, respirations. Inserting an airway or initiating mechanical ventilation may be necessary. Question 73 To assess the effectiveness of an analgesic administered to a 4-year-old, what intervention is best for the nurse to implement? Question 74 A nurse provides the parents with information on health maintenance for their child with sickle cell disease. Which information reflected by the parents indicates understanding of the child's care? Correct Answer Question 75 The nurse is assessing an 8-month-old child who has a medical diagnosis of Tetrology of Fallot. Which symptom is this client most likely to exhibit? A 4-year- old can readily identify with simple pictures to show the nurse how he/she is feeling. Rationale: Use a happy-face/sad- face pain scale. Correct Answer vasocclusive crisis. Adequate fluid intake decreases the viscosity of the blood which helps decrease the incidence of Rationale : Plenty of fluids should be consumed daily.