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Pediatric Nursing Exam 2026/2027: 200
NCLEX-Style Questions & Answers with
Rationales for Nursing Students, RN
Licensure, and Clinical Success
Description: Download the 2026/2027 Pediatric Nursing Exam with 200 evidence-based questions covering growth & development, neonatal care, diabetes management, immunizations, and critical care. Includes detailed rationales, priority nursing interventions, and family-centered care strategies. Perfect for NCLEX-RN preparation, nursing school exams, and clinical practice. Start mastering pediatric nursing today!
Pediatric Nursing Exam 2026/2027: 200 Questions & Answers
SECTION A: PEDIATRIC ASSESSMENT AND DEVELOPMENTAL
CONSIDERATIONS
Question 1 A 5-year-old child presents for a well-child visit. Which of the following developmental milestones would the nurse expect this child to have achieved? A) Tying shoelaces independently B) Drawing a circle and copying a square C) Riding a tricycle D) Printing their first and last name Answer: B Explanation: At age 5, children typically can draw a circle and copy a square. They also begin to print some letters, but not typically their full name independently. Tying shoelaces usually occurs around age 6, and riding a tricycle is expected earlier, around 3-4 years of age. Understanding developmental milestones is essential for pediatric nurses to accurately assess growth and identify potential delays. Question 2 A pediatric nurse is preparing to obtain a height and weight measurement for a 5-year-old patient. Which of the following actions demonstrates correct procedure? A) Weigh the child with shoes on and measure height while seated B) Ask the child to remove shoes and stand on the scale with light clothing C) Weigh the child fully clothed and measure height with shoes on D) Measure height while the child is lying flat on the examination table Answer: B Explanation: Accurate anthropometric measurements require children to be weighed without shoes and with light clothing to ensure precision. Height should be measured with the child standing upright against a stadiometer. Weighing with shoes or heavy clothing can significantly affect accuracy, which is critical for monitoring growth patterns and calculating appropriate medication dosages.
Question 5 A 7-year-old child is scheduled for vision screening. Which of the following techniques is most appropriate for this age group? A) Snellen chart testing in a well-lit hallway B) Random dot stereopsis testing C) Red reflex examination only D) Ishihara color plates Answer: A Explanation: The Snellen chart is the standard tool for vision screening in school-aged children. Testing should be conducted in a well-lit area at the appropriate distance. The random dot stereopsis test is more suitable for pre-school aged children, while the Ishihara test specifically screens for color blindness. Question 6 A nurse is assessing a 2-year-old child's language development. Which of the following findings would be expected? A) Speaking in three- to four-word sentences B) Using pronouns correctly C) Having a vocabulary of approximately 50 words D) Using past tense correctly Answer: C Explanation: By age 2, children typically have a vocabulary of approximately 50 words and begin combining words into two-word phrases. Three- to four-word sentences and correct pronoun use are more typical of a 3-year-old. Past tense usage develops later in the preschool years. Question 7 A 4-month-old infant is being assessed. Which of the following reflexes should have disappeared? A) Moro reflex B) Rooting reflex
C) Tonic neck reflex D) All of the above Answer: D Explanation: The Moro, rooting, and tonic neck reflexes typically disappear by 4 months of age. The persistence of primitive reflexes beyond the expected time frame may indicate neurological impairment. Reflex assessment is an important component of the neonatal and infant neurological examination. Question 8 A nurse is assessing a preschool-aged child's fine motor skills. Which of the following would be an expected finding? A) The child can write their first name B) The child can draw a circle C) The child can tie shoelaces D) The child can use scissors to cut out shapes Answer: B Explanation: Drawing a circle is an expected fine motor skill for a preschool-aged child (3- 5 years). Writing a first name typically develops around age 5-6, tying shoelaces around age 6, and using scissors to cut out shapes is a skill that develops during the preschool years but may be refined later. Question 9 A nurse is evaluating a school-age child's cognitive development. Which of the following is consistent with Piaget's concrete operational stage? A) The child understands abstract concepts B) The child can think logically about concrete events C) The child engages in magical thinking D) The child is egocentric Answer: B Explanation: The concrete operational stage (7-11 years) is characterized by logical thinking about concrete events. Children in this stage understand conservation and can organize
Question 12 A nurse is caring for a neonate with suspected hypoglycemia. The initial blood glucose level is 34 mg/dL. Which of the following actions should the nurse take first? A) Administer intravenous dextrose B) Obtain a confirmatory laboratory glucose level C) Feed the infant 10ml of formula via oral or gavage D) Place the infant under a radiant warmer Answer: B Explanation: When a point-of-care glucose test indicates hypoglycemia, the next appropriate step is to obtain a laboratory confirmation. This ensures accuracy of the initial result and prevents unnecessary interventions. Prompt treatment with formula or glucose is necessary once confirmed, as prolonged hypoglycemia in neonates can lead to neurological complications. Question 13 A neonate with respiratory distress has an oxygen saturation of 86% on room air. Which of the following interventions is most appropriate? A) Administer supplemental oxygen via oxyhood B) Place the infant in Trendelenburg position C) Initiate chest physiotherapy D) Administer surfactant therapy Answer: A Explanation: An oxygen saturation below 90% warrants intervention. Placing the infant under an oxyhood and titrating oxygen to maintain saturations above 90% is appropriate initial management. Trendelenburg positioning is not indicated in this scenario, and surfactant therapy would depend on the underlying cause of respiratory distress.
Question 14 A nurse is caring for a neonate with hyperbilirubinemia. Which of the following interventions is essential when initiating phototherapy? A) Placing protective eye shields over the infant's eyes B) Administering prophylactic antibiotics C) Increasing the infant's environmental temperature D) Monitoring the infant's blood pressure hourly Answer: A Explanation: When an infant is placed under phototherapy, eye shields must be applied to protect the eyes from potential damage from the light therapy. The shields should be checked frequently to ensure proper placement. Adequate hydration is also important, and the infant should be monitored for side effects including temperature instability and loose stools. Question 15 A parent expresses concern about neonatal heat loss. Which of the following statements by the nurse demonstrates accurate understanding of thermoregulation in newborns? A) "Newborns are at higher risk for heat loss due to their proportionally large body surface area" B) "The primary method of heat loss in newborns is through evaporation during diaper changes" C) "Newborns produce adequate body heat through brown fat metabolism without external support" D) "Wrapping the infant in two blankets is sufficient to prevent heat loss" Answer: A Explanation: Newborns have a larger body surface area relative to body weight, making them more susceptible to heat loss. They have limited ability to generate heat and depend on environmental temperature maintenance. While brown fat metabolism does occur, it is easily overwhelmed, making environmental temperature support critical.
C) Hyperactivity D) Polycythemia Answer: B Explanation: Poor feeding is a common sign of sepsis in neonates. Other signs include temperature instability (hypothermia or hyperthermia), lethargy, respiratory distress, and jaundice. Early recognition is critical for timely intervention and improved outcomes. Question 19 A nurse is caring for a neonate receiving gavage feedings. Which of the following actions is essential? A) Elevating the head of the bed during and after the feeding B) Administering feedings at room temperature C) Feeding the infant in a side-lying position only D) Discarding any unused formula immediately Answer: A Explanation: Elevating the head of the bed during and after gavage feedings helps reduce the risk of aspiration and gastroesophageal reflux. While proper feeding technique and temperature are important, head elevation is crucial for safety. The infant should be monitored for signs of feeding intolerance. Question 20 A nurse is assessing a neonate's Apgar score. Which of the following is not a component of the Apgar scoring system? A) Heart rate B) Respiratory effort C) Reflex irritability D) Gestational age Answer: D Explanation: The Apgar score assesses heart rate, respiratory effort, muscle tone, reflex irritability, and color. Gestational age is not a component of the Apgar score and is assessed
separately using methods such as the Ballard score. The Apgar score provides a quick assessment of the newborn's transition to extrauterine life. SECTION C: PEDIATRIC RESPIRATORY AND GASTROINTESTINAL CONDITIONS Question 21 A 10-year-old patient with cystic fibrosis is experiencing decreased activity tolerance and crackles noted in both lung bases. Which of the following nursing interventions should be prioritized? A) Administer prescribed pancreatic enzymes B) Provide a high-calorie, high-fat meal C) Perform chest physiotherapy and postural drainage D) Restrict fluid intake to prevent respiratory distress Answer: C Explanation: Chest physiotherapy is essential for mobilizing secretions in patients with cystic fibrosis, particularly when crackles are present. This intervention helps clear airway obstruction and improve gas exchange. While pancreatic enzymes and nutritional support are important aspects of cystic fibrosis management, the priority in this scenario is addressing impaired gas exchange. Question 22 A patient with cystic fibrosis is prescribed pancreatic enzymes. When should the nurse instruct the patient to take these enzymes? A) At bedtime on an empty stomach B) With each meal and snack C) Only when symptoms of malabsorption occur D) Once daily with the largest meal Answer: B Explanation: Pancreatic enzymes should be taken with every meal and snack to ensure adequate digestion of fats and proteins. Taking enzymes with food allows them to mix with
Question 25 Following appendectomy, the nurse should monitor for which of the following signs of infection? A) Increased appetite and thirst B) Redness around the surgical site and increased drainage C) Decreased white blood cell count D) Resolution of pain and nausea Answer: B Explanation: Signs of surgical site infection include redness, warmth, swelling, increased drainage, and fever. These findings require prompt notification of the healthcare provider. A normal post-operative course would include gradual improvement in pain, return of bowel sounds, and tolerance of oral intake. Question 26 A nurse is assessing a child with asthma. Which of the following is a sign of a severe asthma exacerbation? A) Mild wheezing B) Respiratory rate of 18 breaths per minute C) Inability to speak in full sentences D) Oxygen saturation of 95% Answer: C Explanation: Inability to speak in full sentences is a sign of severe respiratory distress. Other signs of severe asthma exacerbation include use of accessory muscles, retractions, and oxygen saturation below 90%. Early intervention with bronchodilators and oxygen therapy is essential. Question 27 A child is prescribed a nebulizer treatment. Which of the following should the nurse include in the teaching for the parents? A) Administer the treatment only when the child is having symptoms B) Use the medication until the nebulizer cup is dry
C) Clean the nebulizer equipment after each use D) Administer the treatment at bedtime only Answer: C Explanation: Nebulizer equipment should be cleaned after each use to prevent infection. Medications should be administered as prescribed, not only when symptoms are present. The treatment should be continued until the medication is completely nebulized, and the cup should be emptied. Regular administration as prescribed maintains bronchodilation. Question 28 A child is being evaluated for possible pneumonia. Which of the following findings would the nurse expect? A) Clear breath sounds B) Diminished breath sounds with crackles C) Prolonged expiration D) Stridor on inspiration Answer: B Explanation: Diminished breath sounds with crackles are characteristic findings in pneumonia. Prolonged expiration is typically seen in asthma, while stridor indicates upper airway obstruction. Clear breath sounds would not suggest pneumonia, though assessment findings can vary depending on the severity and location of the infection. Question 29 A nurse is providing education to parents about preventing respiratory infections in their child. Which of the following should be included? A) Routine use of antibiotics to prevent infections B) Hand hygiene and avoiding exposure to sick individuals C) Using over-the-counter cough medications for prevention D) Limiting outdoor play during all seasons Answer: B Explanation: Hand hygiene and avoiding exposure to sick individuals are effective prevention strategies. Antibiotics should not be used prophylactically for respiratory
Question 32 When providing education to a child newly diagnosed with type 1 diabetes about carbohydrate counting, which of the following is the most effective teaching approach? A) Providing a written handout on carbohydrate counting B) Demonstrating carbohydrate counting using a reference tool and having the child practice C) Asking the parent to teach carbohydrate counting at home D) Showing a video on carbohydrate counting Answer: B Explanation: The most effective teaching approach involves demonstration and return demonstration, which allows the learner to practice the skill with feedback. Carbohydrate counting requires practical application skills, and having the child and family practice with a reference tool enhances learning and confidence. This method follows adult learning principles that emphasize active participation. Question 33 A child with type 1 diabetes expresses concern about being "different" from peers at school. Which response by the nurse is most therapeutic? A) "You can do everything your friends do as long as you manage your diabetes" B) "I understand you feel different; let me teach you how to do injections" C) "Don't worry about feeling different; many children have diabetes" D) "Let's discuss what being different means to you and how diabetes affects your activities" Answer: D Explanation: This response uses therapeutic communication by exploring the child's perception of being different and addressing concerns about diabetes impact on daily activities. Validating the child's feelings and providing age-appropriate information promotes coping and adjustment to the diagnosis. It acknowledges the concern while reinforcing that diabetes management does not prevent normal activities.
Question 34 A nurse is teaching carbohydrate counting using a reference tool to a child and family. Which learning outcome indicates the teaching has been effective? A) The child states that sugar is the only thing that affects blood glucose B) The family can identify appropriate food substitutions using the reference tool C) The child agrees to follow a strict meal plan without changes D) The family states they will avoid all carbohydrates Answer: B Explanation: The ability to use a reference tool to make appropriate food substitutions demonstrates effective learning and application of carbohydrate counting skills. This approach provides flexibility in food choices while maintaining blood glucose control. Avoiding all carbohydrates or believing only sugar affects blood glucose indicates a misunderstanding of diabetes management principles. Question 35 A child with type 1 diabetes is prescribed a new medication regimen. The nurse should include which of the following in the education plan? A) Insulin should be administered only during mealtimes B) Blood glucose monitoring is unnecessary once stable on the regimen C) The child should have a high-sugar snack immediately before physical activity D) Sick day management includes frequent blood glucose monitoring and insulin adjustments Answer: D Explanation: Sick day management is critical for children with type 1 diabetes. During illness, blood glucose can become unstable, and the child may require more frequent monitoring and insulin adjustments based on glucose levels and ketone testing. Following a sick day protocol helps prevent diabetic ketoacidosis and other complications.
Question 38 A child with type 1 diabetes is experiencing symptoms of ketoacidosis. Which of the following findings would the nurse expect? A) Respiratory depression B) Fruity breath odor C) Increased pH level D) Normal blood glucose levels Answer: B Explanation: A fruity, acetone-like breath odor is characteristic of diabetic ketoacidosis, which results from the production of ketones. Other findings include hyperglycemia, metabolic acidosis, dehydration, and Kussmaul respirations. Prompt recognition and treatment are essential to prevent complications. Question 39 A nurse is educating a family about continuous glucose monitoring. Which of the following is the primary benefit of this technology? A) It eliminates the need for insulin injections B) It provides real-time glucose readings C) It automatically adjusts insulin doses D) It prevents all episodes of hypoglycemia Answer: B Explanation: Continuous glucose monitoring provides real-time glucose readings, allowing for immediate identification of trends and prevention of extreme glucose excursions. While it enhances diabetes management, it does not eliminate the need for insulin injections, automatically adjust doses, or prevent all hypoglycemic episodes. Question 40 A child is newly diagnosed with type 1 diabetes. The nurse should include which of the following in the discharge teaching? A) Insulin needs will decrease over the first year B) The child will require lifelong insulin therapy
C) The child can stop insulin after the "honeymoon period" D) Oral medications can replace insulin in children Answer: B Explanation: Type 1 diabetes requires lifelong insulin therapy. While there may be a "honeymoon period" during which insulin requirements decrease, the child will still require insulin indefinitely. Oral medications are not effective for type 1 diabetes management and are typically used in type 2 diabetes. SECTION E: PEDIATRIC INFECTIOUS DISEASE AND IMMUNIZATION Question 41 A pediatric nurse is preparing to administer immunizations to a 5-year-old child. Which combination of vaccines is typically scheduled for this age? A) MMR, DTaP, and IPV B) MMR, Varicella, and Hepatitis A C) DTaP, Hepatitis B, and Hib D) PCV13, Rotavirus, and Influenza Answer: A Explanation: At the 4-5 year well-child visit, the recommended immunizations include MMR (second dose), DTaP (fifth dose), and IPV (fourth dose). These represent the final doses in the recommended childhood immunization schedule for these vaccines. Some children may also receive the Varicella vaccine at this visit. Question 42 Before administering immunizations to a child, which of the following actions is most critical? A) Asking the parent to comfort the child during administration B) Checking the child's temperature C) Documenting the injection sites D) Administering antipyretics before immunization Answer: B
