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Master pediatric nursing for 2026/2027 with 120 high-yield NCLEX-style questions covering growth milestones, vaccines, adolescent health, and STIs. Includes complete answer key with rationales. Pediatric nursing exam questions 2026, NCLEX-style pediatrics Q&A with rationales, Toddler developmental milestones nursing, Adolescent health nursing NCLEX, Child health nursing study guide PDF
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Description: Master pediatric nursing for 2026/2027 with 120 high-yield NCLEX-style questions covering growth milestones, vaccines, adolescent health, and STIs. Includes complete answer key with rationales. Download the ultimate study guide now and pass your pediatric nursing exam on the first try!
SECTION A: TODDLER DEVELOPMENT AND CARE (Questions 1-20)
1. A 2-year-old toddler has hearing loss caused by recurrent otitis media. What treatment does the nurse anticipate that the practitioner will recommend? A. Antibiotic ear drops B. Myringotomy C. Mastoidectomy D. Corticosteroid therapy Answer: B. Myringotomy Explanation: Myringotomy is a surgical opening into the eardrum to permit drainage of accumulated fluid associated with otitis media. Antibiotic ear drops are not used because they would obscure visualization of the tympanic membrane. Mastoidectomy would not relieve pressure within inflamed ears. Antibiotics, not steroids, are prescribed for infectious processes. 2. The nurse is educating parents about frequent upper respiratory tract infections in toddlers. What does the nurse identify as the primary cause? A. Environmental allergens B. Anatomical differences C. Immature immune system D. Poor hygiene practices Answer: C. Immature immune system Explanation: Toddlers have an immature immune system that has not yet developed full immunologic competence, making them more susceptible to upper respiratory tract infections. While environmental factors and hygiene play roles, the immaturity of the immune system is the fundamental cause.
Explanation: Parallel play is a typical expression of toddlers' social development. As part of the socialization process, toddlers enjoy playing beside other children (parallel play) but do not socially interact with them. This is developmentally appropriate and not a sign of immaturity.
6. A nurse is obtaining a health history from the mother of a 15-month-old toddler with celiac disease. What characteristic stool finding does the nurse expect the mother to report? A. Blood-tinged and mucoid B. Small, hard, and pellet-like C. Steatorrhea (fatty, foul-smelling, frothy, bulky) D. Watery and explosive Answer: C. Steatorrhea (fatty, foul-smelling, frothy, bulky) Explanation: Steatorrhea occurs with celiac disease because of intolerance to gluten. Toxic substances accumulate and damage intestinal mucosal cells, causing diarrhea with fatty, foul- smelling, frothy, and bulky stools. 7. What is the priority nursing care in the immediate postoperative period for a toddler with a newly applied hip spica cast? A. Monitoring for signs of infection B. Checking peripheral circulation C. Assessing pain level D. Positioning the child comfortably Answer: B. Checking peripheral circulation Explanation: Priority nursing care for any cast application includes checking the color and temperature of the area surrounding the cast to ensure the cast is not too tight. A tight cast compresses arteries and veins, impairing circulation. While other assessments are important, circulatory assessment is the priority. 8. The parent of a 2-year-old reports that the child just consumed several multivitamins with iron. What should the nurse advise the parent to do? A. Induce vomiting immediately B. Administer activated charcoal
C. Call the Poison Control Center D. Take the child to the emergency room Answer: C. Call the Poison Control Center Explanation: The Poison Control Center provides the best guidance for treatment of excess ingestion of a substance. Depending on the amount ingested and the child's age and response, enemas, lavage, or chelation therapy with deferoxamine (Desferal) may be recommended.
9. A nurse in a daycare center is teaching aides about the play behavior of 2-year-old toddlers. What is this type of play called? A. Solitary play B. Associative play C. Cooperative play D. Parallel play Answer: D. Parallel play Explanation: Toddlers play independently but beside other children. They are aware of other children, often grabbing toys from them, but do not socially interact with them. This is characteristic of parallel play. 10. Elbow restraints are prescribed for an 18-month-old toddler following cleft palate surgery. The nurse explains that the restraints are needed to prevent the child from doing what? A. Scratching the surgical site B. Placing fingers or objects in the mouth C. Removing the intravenous line D. Pulling on dressings Answer: B. Placing fingers or objects in the mouth Explanation: The suture lines in the mouth must be protected. Because the toddler uses the mouth to explore the environment, elbow restraints are needed to keep the child from placing fingers or objects in the mouth. This prevents disruption of the surgical repair.
Explanation: Explaining the reason for the time-out before and after reinforces the child's association of the time-out with the undesirable behavior, allowing the child to learn to control those behaviors. Time-out should be 1 minute per year of age, not used as a threat, and should not be contingent on apologies.
14. The nurse is caring for a young child diagnosed with lead poisoning. Which finding indicates high-dose exposure to lead? A. Abdominal pain B. Anemia C. Blindness D. Constipation Answer: C. Blindness Explanation: Blindness indicates encephalopathy as a result of high-dose exposure to lead. Other manifestations of lead poisoning include abdominal pain, anemia, and constipation, but blindness suggests severe neurological involvement from high-dose exposure. 15. The nurse is providing education to parents of a preschool-age client experiencing a severe fear of the dark. Which treatment option should the nurse recommend? A. Hypnotherapy B. Pharmacological intervention C. Repetition of brave statements D. Systematic desensitization Answer: C. Repetition of brave statements Explanation: Repetition of brave statements helps preschool-age children develop coping strategies for fears. This cognitive-behavioral approach empowers children to manage their fears independently and is developmentally appropriate for this age group. 16. A 3-year-old child is admitted with a tentative diagnosis of Wilms tumor. What historical finding supports this diagnosis? A. Abdominal swelling B. Hematuria C. Hypertension D. Fever
Answer: A. Abdominal swelling Explanation: Wilms tumor is a nephroblastoma first observed as a firm, painless intra- abdominal mass located on one side of the abdomen. Abdominal swelling is the most common presenting sign, while hematuria, hypertension, and fever are less common or later findings.
17. What change is seen when a child transitions from toddlerhood to the preschool stage? A. Decreased appetite B. More consistent napping patterns C. Extension of bedtimes D. Decreased need for physical activity Answer: C. Extension of bedtimes Explanation: Preschoolers often begin to extend their bedtimes, resisting sleep and using various strategies to delay going to bed. This change reflects their developing autonomy and cognitive abilities. 18. At which age would the nurse anticipate the appearance of an imaginary friend in a preschool-age client? A. 2 years B. 3 years C. 4 years D. 5 years Answer: B. 3 years Explanation: Imaginary friends typically appear by 3 years of age and can last throughout the preschool stage of development. If an imaginary friend has not appeared by this age, it is unlikely to emerge later in the preschool years. 19. After a tonsillectomy, which finding alerts the nurse to suspect the initial stage of hemorrhage? A. Frequent swallowing B. Audible snoring
22. Which type of language development is expected in 4-year-old children? A. Uses two-word phrases B. Speaks in complete sentences C. Knows simple songs D. Has a vocabulary of 500 words Answer: C. Knows simple songs Explanation: By age 4, children typically know simple songs and can sing them. They also have vocabulary of 1500-2000 words and speak in complete sentences. Knowing simple songs is a characteristic language milestone for 4-year-olds. 23. A 4-year-old child with nephrotic syndrome is admitted to the pediatric unit. What clinical finding does the nurse expect when assessing this child? A. Dark, frothy urine B. Clear, dilute urine C. Scant, concentrated urine D. Cloudy, foul-smelling urine Answer: A. Dark, frothy urine Explanation: Dark, frothy urine is characteristic of a child with nephrotic syndrome. Large amounts of protein in the urine cause it to take this appearance. This reflects the massive proteinuria associated with the condition. 24. A 4-year-old child is admitted with a diagnosis of Wilms tumor. Considering the unique needs of a child with this diagnosis, what sign should be placed on the child's bed? A. "Monitor vital signs frequently" B. "Do not palpate the abdomen" C. "Maintain strict intake and output" D. "Limit visitors" Answer: B. "Do not palpate the abdomen"
Explanation: Palpation of the abdomen increases the risk of tumor rupture in Wilms tumor. This precaution is essential to prevent dissemination of malignant cells and potential hemorrhage.
25. A student nurse is assessing socialization skills in 3-year-old and 4-year-old children. Which similar characteristic may be seen in children of both ages? A. Both exhibit cooperative play B. Both have fear C. Both can share easily D. Both are independent in dressing Answer: B. Both have fear Explanation: Both 3-year-old and 4-year-old children experience fears, though the nature of their fears may differ. Three-year-olds may fear the dark and animals, while 4-year-olds may fear physical injury. Fear is a common developmental characteristic at both ages. 26. Which areas are sources of stress in 4-year-old children? Select all that apply. A. Attention B. Insecurity C. Activity level D. Speech development E. Toilet training Answer: A, B, C. Attention, Insecurity, Activity level Explanation: Sources of stress in 4-year-old children include attention-seeking needs, feelings of insecurity, and managing their activity level. Speech development is more of a stressor in 3-year-olds, and toilet training is typically mastered by age 4. 27. What is the average weight of a preschooler at 5 years of age? A. 32 pounds (14.5 kg) B. 36 pounds (16.3 kg) C. 41 pounds (18.6 kg) D. 46 pounds (20.9 kg) Answer: C. 41 pounds (18.6 kg)
Answer: C. They experience what the preschooler wants to remember Explanation: Imaginary playmates experience what a preschooler wants to remember, serving as a mechanism for processing experiences and emotions. This is a normal developmental phenomenon and not indicative of psychiatric disorder or social isolation.
31. A child undergoes tonsillectomy and adenoidectomy for recurrent respiratory tract infections. After surgery, what should the nurse teach the parents to do? A. Offer ice chips B. Provide warm fluids C. Use a straw for drinking D. Offer citrus juices Answer: A. Offer ice chips Explanation: Ice chips are soothing to the surgical site and promote vasoconstriction, which helps reduce bleeding. Warm fluids, straws, and acidic juices should be avoided in the immediate postoperative period. 32. What is the average weight of a 3-year-old child? A. 28 pounds (12.7 kg) B. 32 pounds (14.5 kg) C. 36 pounds (16.3 kg) D. 40 pounds (18.1 kg) Answer: B. 32 pounds (14.5 kg) Explanation: The average weight of a 3-year-old child is approximately 32 pounds (14.5 kg). This represents continued growth from the toddler years. 33. What should a nurse emphasize when teaching lifelong management of type 1 diabetes to an adolescent? A. Maintaining a strict diet B. Inspecting both feet frequently for signs of trauma C. Monitoring blood glucose levels weekly D. Exercising only when blood glucose is elevated Answer: B. Inspecting both feet frequently for signs of trauma
Explanation: Adolescents with type 1 diabetes should inspect their feet frequently for signs of trauma due to the risk of neuropathy and poor wound healing. This is an essential component of lifelong diabetes management.
34. A 15-year-old with type 1 diabetes has a history of noncompliance with the therapy regimen. What must the nurse consider about the teenager's developmental stage before starting a counseling program? A. The desire for peer acceptance is paramount B. The struggle for identity is typical C. The need for independence is overwhelming D. The fear of needles is common Answer: B. The struggle for identity is typical Explanation: The struggle for identity is typical of adolescence. Noncompliance with diabetes therapy may reflect the adolescent's struggle for autonomy and identity formation. Counseling should address these developmental needs. 35. Which statements regarding adolescents are true? Select all that apply. A. The United States has the highest rate of teenage pregnancy B. Anorexia nervosa and bulimia are eating disorders found in adolescence C. Acne is most commonly caused by dietary factors D. Sleep requirements decrease during adolescence Answer: A, B. The United States has the highest rate of teenage pregnancy; Anorexia nervosa and bulimia are eating disorders found in adolescence Explanation: The United States has one of the highest rates of teenage pregnancy among developed countries. Anorexia nervosa and bulimia are eating disorders commonly seen in adolescence. Acne is primarily caused by hormonal factors, not diet, and sleep requirements do not decrease during adolescence. 36. What is the most common cause of ophthalmia neonatorum in infants born to adolescent mothers? A. Gonorrhea B. Chlamydia
39. An adolescent newly diagnosed with type 1 diabetes asks a nurse about exercise. What is the best response? A. "Exercise is not recommended with diabetes" B. "Extra snacks are needed before exercise" C. "Exercise should be avoided if blood glucose is normal" D. "Insulin should be doubled before exercise" Answer: B. "Extra snacks are needed before exercise" Explanation: Extra snacks are needed before exercise to prevent hypoglycemia. Exercise increases glucose utilization, and without adequate carbohydrate intake, blood glucose levels can drop dangerously low. 40. What over-the-counter drugs are used to treat vulvovaginal candidiasis? A. Metronidazole and clindamycin B. Miconazole and clotrimazole C. Fluconazole and itraconazole D. Amphotericin B and nystatin Answer: B. Miconazole and clotrimazole Explanation: Miconazole and clotrimazole are over-the-counter antifungal medications used to treat vulvovaginal candidiasis. They are available in various formulations for topical application. 41. A nurse on the pediatric unit is planning recreational activities for a 4-year-old with an exacerbation of nephrotic syndrome. What are the most appropriate activities? A. Playing ball and running games B. Watching cartoon videos and listening to stories C. Painting and drawing at a table D. Playing with blocks and puzzles Answer: B. Watching cartoon videos and listening to stories Explanation: Watching cartoon videos and listening to stories are quiet, pleasurable pastimes for a 4-year-old with limited energy due to nephrotic syndrome. These activities respect the child's developmental level while accommodating physical limitations.
42. A 4-year-old child shows a motor response score of 3 on the Glasgow Coma Scale. What clinical finding does this signify? A. Localizes pain B. Withdraws to pain C. Abnormal flexion D. No motor response Answer: C. Abnormal flexion Explanation: On the Glasgow Coma Scale, a motor response score of 3 indicates abnormal flexion (decorticate posturing). This reflects significant neurological impairment requiring immediate intervention. 43. Which step should the nurse follow for the administration of ear drops in children of 4 to 5 years of age? A. Pull the auricle down and back B. Pull the auricle up and out C. Push the tragus forward D. Instill drops without manipulating the ear Answer: B. Pull the auricle up and out Explanation: For children over 3 years of age, the auricle should be pulled up and out to straighten the ear canal. This technique allows for proper instillation of ear drops in children aged 4 to 5 years. 44. Which description provided by the parent of a preschool-age client would suggest to the nurse that the child is experiencing sleep terrors? A. Waking up crying B. Sweating profusely C. Talking in sleep D. Sleepwalking Answer: B. Sweating profusely Explanation: Profuse sweating is a characteristic feature of sleep terrors in preschool-age children. Other features may include screaming, intense fear, and autonomic arousal. Unlike
Answer: A. Fear of bodily mutilation Explanation: Preschoolers are likely to experience fear of bodily mutilation and loss of control caused by physical restriction, loss of routines, and enforced dependency. Regression or overdependency may also occur.
48. A nurse is obtaining a health history from the parents of a preschooler with celiac disease. What characteristic does the nurse expect when the parents describe their child's stools? A. Large, pale, foul-smelling B. Small, dark, and hard C. Loose, green, and mucousy D. Bloody and purulent Answer: A. Large, pale, foul-smelling Explanation: Celiac disease causes large, pale, foul-smelling stools (steatorrhea) due to malabsorption of fats. The stools contain undigested fat and are characteristic of this condition. 49. The preschool-age client is learning sociocultural mores. What should this imply to the nurse regarding this client? A. The child is developing a conscience B. The child is experiencing role confusion C. The child is developing moral reasoning D. The child is establishing identity Answer: A. The child is developing a conscience Explanation: As the preschool-age client learns sociocultural mores, the child is developing a conscience. This reflects the internalization of cultural and social norms, consistent with Erikson's initiative versus guilt stage.
50. A preschool-aged child with leukemia undergoing chemotherapy is susceptible to rectal ulcerations. What should the nurse recommend to the parents to lessen this problem? A. Clean the child's perianal area after each bowel movement B. Apply topical corticosteroids to the area C. Administer stool softeners daily D. Restrict the child's fluid intake Answer: A. Clean the child's perianal area after each bowel movement Explanation: Cleaning the child's perianal area after each bowel movement helps prevent rectal ulcerations by reducing irritation and infection risk. This is particularly important in immunocompromised children. 51. Which clinical manifestation would cause the nurse to suspect that a preschool-age client ingested a corrosive agent, such as bleach? A. Drooling B. Vomiting C. Abdominal pain D. Coughing Answer: A. Drooling Explanation: Drooling is often associated with the ingestion of a corrosive agent, such as bleach, due to oral and esophageal burns causing difficulty swallowing. This sign warrants immediate medical attention. 52. The nurse is assessing a 5-year-old child using the Glasgow Coma Scale after surgery. What rating should the nurse assign if the child shows a confused verbal response? A. 3 B. 4 C. 5 D. 6 Answer: B. 4
