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NCLEX pediatrics practice questions

20 free NCLEX-style pediatric questions: growth and development, dehydration, respiratory distress, heart defects, safety and poisoning, with answers and rationales.

Tap an answer to check it, or open "Show the answer and rationale" under each question. Every client is fictional. For exam practice only, not medical advice.

Question 1 of 20

A 9-month-old who weighs 19.8 lb (9 kg) has moderate dehydration from viral gastroenteritis. The provider prescribes oral rehydration solution 100 mL/kg over 4 hours, given in small, frequent amounts by syringe. How many milliliters should the nurse teach the parent to give each hour?

  1. 495 mL
  2. 900 mL
  3. 25 mL
  4. 225 mL
Show the answer and rationale

Answer: D

The replacement volume is 100 mL × 9 kg = 900 mL over 4 hours, so 900 ÷ 4 = 225 mL each hour, given in small amounts every few minutes and increased as tolerated, with extra solution to replace ongoing stool and vomiting losses. The runner-up, 900 mL, is the whole 4-hour volume rather than the hourly amount. 495 mL uses the weight in pounds (100 × 19.8 ÷ 4), and 25 mL divides the dose by the hours but skips multiplying by the weight.

📚 Learn it: Pediatric Vital Signs and Dehydration Math

Question 2 of 20

During an infant CPR class, a parent asks what to do if her 8-month-old chokes on a piece of food, cannot cry, cough or make a sound, and is still responsive. Which instruction should the nurse give?

  1. Alternate 5 back blows and 5 chest thrusts until the food comes out
  2. Give 2 rescue breaths to push air past the food, then check for a pulse
  3. Give quick upward thrusts just above the navel until the food comes out
  4. Sweep a finger through the back of the mouth to hook out the food
Show the answer and rationale

Answer: A

An infant who cannot cry, cough or make a sound has a severe airway obstruction, so the rescuer holds the infant face down along the forearm with the head lower than the chest, gives 5 back blows between the shoulder blades, turns the infant and gives 5 chest thrusts, and repeats until the food comes out or the infant stops responding, while someone calls 911. Abdominal thrusts are the strongest distractor because they are used for older children and adults, but not for infants under 1 year. A blind finger sweep can push the food deeper, and rescue breaths begin only if the infant becomes unresponsive and CPR is started.

📚 Learn it: Croup, Epiglottitis and the Tongue Blade You Never Use

Question 3 of 20

A nurse at a pediatric cardiology clinic reviews the records of four children who have dental cleanings scheduled next week. For which child should the nurse expect the provider to prescribe a dose of amoxicillin before the cleaning?

  1. A 4-year-old who had Kawasaki disease 2 years ago and has normal coronary arteries
  2. A 12-year-old with a bicuspid aortic valve and mild aortic stenosis
  3. A 9-year-old whose ventricular septal defect was closed with a patch 5 years ago, with no leak
  4. A 6-year-old whose atrial septal defect was closed with a device 4 months ago
Show the answer and rationale

Answer: D

Antibiotic prophylaxis before dental work that manipulates the gums is reserved for the highest-risk conditions, which include a congenital defect completely repaired with prosthetic material or a device during the first 6 months after the procedure, before new tissue covers it; the usual pediatric dose is a single oral dose of amoxicillin 50 mg/kg 30 to 60 minutes before the procedure. The patched septal defect is the runner-up, but a repair more than 6 months old with no residual defect no longer qualifies. A bicuspid aortic valve and past Kawasaki disease with normal coronary arteries are not on the highest-risk list.

📚 Learn it: Tet Spells, Coarctation and the Strawberry Tongue

Question 4 of 20

A nurse in a pediatric emergency department is triaging four infants brought in because of vomiting. Which infant should the nurse see first?

  1. A 10-day-old who has vomited bright green fluid three times since the last feeding
  2. A 7-month-old with 2 days of vomiting and diarrhea, moist lips and 4 wet diapers today
  3. A 4-week-old with projectile vomiting after every feeding who wants to eat again right away
  4. A 3-month-old who spits up small amounts after most feedings and is gaining weight
Show the answer and rationale

Answer: A

Bright green, bilious vomiting in a newborn means the blockage lies beyond the stomach, and it can be malrotation with midgut volvulus, in which the twisted bowel loses its blood supply, so it is a surgical emergency: the infant is seen at once, kept NPO and prepared for imaging. Projectile vomiting with constant hunger is the runner-up; it points to pyloric stenosis, which needs prompt care, but the vomit is not bilious, and fluid and electrolyte correction comes before a planned surgery. Small spit-ups in a thriving infant are reflux, and moist lips with 4 wet diapers show mild dehydration at most.

📚 Learn it: Olive, Currant Jelly, Ribbon: The GI Clues

Question 5 of 20

During a well visit, a 16-year-old client makes the following statements. Which statement should the nurse address first?

  1. 'I vape most days now, but at least it isn't real cigarettes.'
  2. 'I take my brother's ADHD pills to focus before big tests.'
  3. 'I'm so stressed about grades that I can't fall asleep.'
  4. 'My friend usually drives us home after he's been drinking.'
Show the answer and rationale

Answer: D

Motor vehicle crashes are a leading cause of death among teens, and riding with a driver who has been drinking puts the client's life at immediate risk, so the nurse addresses it first and helps the client plan a safe alternative, such as calling a parent for a ride with no questions asked. Taking a sibling's stimulant is the strongest distractor, because misusing a prescription drug carries risks of dependence and heart effects, but it is a less immediate threat to life. Daily vaping and stress that disrupts sleep are real concerns worth counseling, but neither carries the same immediate risk of death or injury.

📚 Learn it: Car Seats, Choking Foods, Safe Sleep and Hospitalized Kids

Question 6 of 20 · Select all that apply

A nurse is teaching the parents of a 2-month-old who has a cold how to tell whether the baby is having trouble breathing. Which signs should the nurse teach the parents to report right away? Select all that apply.

  1. Breathing through the nose rather than the mouth
  2. The head bobbing up and down with each breath
  3. Frequent sneezing
  4. The skin pulling in between the ribs with each breath
  5. A grunting sound at the end of each breath
  6. The belly rising and falling more than the chest with each breath
Show the answer and rationale

Answer: B, D, E

Grunting, which partly closes the vocal cords at the end of each breath to keep the small airways open, head bobbing from the use of neck muscles, and retractions between the ribs all signal increased work of breathing, and young infants tire quickly, so these are reported at once. Infants breathe mainly with the diaphragm, so a belly that moves more than the chest is normal, and they breathe mostly through the nose, which is why congestion makes feeding hard and gentle nasal suctioning before feedings helps. Sneezing is a common way infants clear the nose and is not a sign of distress.

📚 Learn it: Croup, Epiglottitis and the Tongue Blade You Never Use

Question 7 of 20

A nurse in a pediatric emergency department receives reports on four children who have had vomiting and diarrhea. Which child should the nurse see first?

  1. A 4-year-old with a blood pressure of 74/48 mm Hg and a heart rate of 146 beats/min
  2. A 7-month-old with a heart rate of 172 beats/min who is crying without tears
  3. A 10-year-old with a blood pressure of 94/58 mm Hg who feels dizzy on standing
  4. A 2-year-old with dry lips, brisk capillary refill and 3 wet diapers since morning
Show the answer and rationale

Answer: A

Children hold their blood pressure until late, so hypotension marks decompensated shock: from 1 to 9 years the lower limit of systolic pressure is about 70 + (2 × age in years), or 78 mm Hg at age 4, so 74 mm Hg with a heart rate of 146 (preschool range about 80 to 120) calls for an isotonic bolus of 20 mL/kg now. The crying infant is tempting, but 172 beats/min is within the awake infant range and absent tears show a deficit that is still compensated. At age 10 the cutoff is 90 mm Hg, so 94/58 is not hypotension, and dry lips with brisk capillary refill fit mild dehydration.

📚 Learn it: Pediatric Vital Signs and Dehydration Math

Question 8 of 20

A nurse on a pediatric unit counts the respiratory rates of four children with respiratory infections, each for a full minute while the child is awake and calm. Which finding requires immediate follow-up?

  1. A 15-year-old with asthma whose respiratory rate is 20 breaths/min
  2. An 8-year-old with pneumonia whose respiratory rate is 36 breaths/min
  3. A 3-month-old with bronchiolitis whose respiratory rate is 50 breaths/min
  4. A 2-year-old with croup whose respiratory rate is 34 breaths/min
Show the answer and rationale

Answer: B

Normal resting rates fall with age: about 30 to 53 breaths/min in infants, 22 to 37 in toddlers, 18 to 25 in school-age children and 12 to 20 in adolescents. A rate of 36 is far above the school-age range, so the 8-year-old is in respiratory distress and needs work of breathing and oxygenation assessed now. The infant's 50 is the runner-up because it is the highest number and infants tire quickly, but it lies within the infant range. The toddler's 34 is within the toddler range, and 20 is at the upper limit of normal for a 15-year-old.

📚 Learn it: Croup, Epiglottitis and the Tongue Blade You Never Use

Question 9 of 20

A nurse is teaching the parents of a 6-week-old with a large ventricular septal defect who tires and sweats during bottle feedings and has gained little weight. Which statement by a parent indicates understanding of the teaching?

  1. 'We'll keep at each feeding until she finishes the bottle, even if it takes an hour.'
  2. 'We'll feed her smaller amounts more often with a soft nipple.'
  3. 'Her sweaty forehead during feedings just means we're dressing her too warmly.'
  4. 'We'll wait until she's crying hard, so she's hungry enough to finish a full bottle.'
Show the answer and rationale

Answer: B

A large left-to-right shunt floods the lungs and leads to heart failure, so feeding is hard work: the infant breathes fast, sweats and tires before taking enough to grow. Smaller, more frequent feedings with a soft nipple, with rests to burp, let her take more with less effort. Pushing on until the bottle is empty is the runner-up because it sounds dedicated, but a long feeding burns the calories she needs and exhausts her. Sweating with feeds is a heart failure sign to report, not overdressing, and letting her cry hard first raises her oxygen and energy needs before the feeding starts.

📚 Learn it: Tet Spells, Coarctation and the Strawberry Tongue

Question 10 of 20

The parents of a 2-month-old who spits up after most feedings but is feeding well and gaining weight are told that the infant has uncomplicated gastroesophageal reflux. Which statement by a parent indicates a need for further teaching?

  1. 'We'll keep laying him flat on his back to sleep, even though he spits up.'
  2. 'We'll raise the head of his crib mattress on a wedge so the milk stays down.'
  3. 'We'll hold him upright for a while after each feeding and burp him often.'
  4. 'Spitting up isn't a problem as long as he's growing and seems comfortable.'
Show the answer and rationale

Answer: B

Raising the head of the crib with a wedge, or using any inclined sleeper, does not reduce reflux and is unsafe, because an infant can slump or slide into a position that blocks the airway; infants with reflux still sleep flat on their backs on a firm surface. Back sleeping is the tempting wrong choice because it sounds risky for an infant who spits up, but a healthy infant clears what comes up by swallowing or coughing, so it is correct. Holding him upright after feedings and burping often are reasonable comfort measures, and spitting up in an infant who is growing and comfortable is expected.

📚 Learn it: Olive, Currant Jelly, Ribbon: The GI Clues

Practice 10 more Pediatrics questions free →

A timed or tutor-mode set in the app, scored by area, with every miss saved for review. Free, no sign-up needed.

Question 11 of 20

A 4-year-old admitted with pneumonia tells the nurse, 'I got sick because I didn't eat my vegetables.' Which response by the nurse is best?

  1. 'That's a silly idea! Vegetables can't make anybody sick.'
  2. 'What makes you think the vegetables made you sick? Can you tell me more about that?'
  3. 'If you eat all your vegetables from now on, you'll get better faster.'
  4. 'Not eating vegetables didn't make you sick. Germs did, and the medicine will help.'
Show the answer and rationale

Answer: D

Preschoolers think magically and often believe an illness or hospital stay is punishment for something they did or did not do, so the nurse corrects the idea plainly and gives a simple, honest cause the child can grasp, which relieves guilt and fear. Inviting the child to say more is the runner-up, a sound technique with an older child or an adult, but on its own it leaves a 4-year-old believing the illness is his fault. Promising a faster recovery for eating vegetables confirms the false link, and calling the idea silly dismisses the worry without replacing it with the truth.

📚 Learn it: Car Seats, Choking Foods, Safe Sleep and Hospitalized Kids

Question 12 of 20

A 10-year-old client who weighs 77 lb (35 kg) is NPO while awaiting surgery to repair a fractured femur. The provider prescribes maintenance IV fluid calculated by the Holliday-Segar method. At what rate should the nurse set the infusion pump?

  1. 75 mL/hr
  2. 146 mL/hr
  3. 110 mL/hr
  4. 94 mL/hr
Show the answer and rationale

Answer: A

Holliday-Segar gives 100 mL/kg a day for the first 10 kg (1,000 mL), 50 mL/kg for the next 10 kg (500 mL) and 20 mL/kg for each kg above 20 (15 × 20 = 300 mL): 1,800 mL ÷ 24 hours = 75 mL/hr, the same result as the hourly 4-2-1 rule (40 + 20 + 15). The runner-up, 94 mL/hr, applies 50 mL/kg to all 25 kg above the first 10 (2,250 mL a day). 110 mL/hr runs the formula on 77 lb instead of 35 kg, and 146 mL/hr gives 100 mL/kg to the whole body weight.

📚 Learn it: Pediatric Vital Signs and Dehydration Math

Question 13 of 20

A 2-year-old with croup is being discharged from the emergency department after a dose of oral dexamethasone. The child has a barking cough, and the stridor heard on arrival is now present only when the child cries. Which statement by the parent indicates understanding of the discharge teaching?

  1. 'Sitting with him in a steamy bathroom will shrink the swelling if the noisy breathing comes back.'
  2. 'If the barking cough keeps him up again tonight, the steroid didn't work and he needs another dose.'
  3. 'We'll come back right away if he has noisy breathing while he's resting quietly.'
  4. 'A cough syrup from the drugstore will quiet the cough so he can sleep.'
Show the answer and rationale

Answer: C

Stridor that is heard while a child rests quietly means the swollen airway below the vocal cords is narrow enough to need urgent treatment, so it is the main reason to return; stridor only with crying fits the mild croup the child is going home with. Steam or cool mist may comfort a child but does not treat croup, so relying on it when stridor at rest appears delays care. The barking cough often lasts several days as croup resolves and does not mean the single dose of dexamethasone failed, and over-the-counter cough medicines are not recommended for young children.

📚 Learn it: Croup, Epiglottitis and the Tongue Blade You Never Use

Question 14 of 20 · Select all that apply

A nurse is reviewing home safety with the parents of a 10-month-old who has started pulling to stand and walking while holding onto furniture. The family lives in a third-floor apartment, and one parent owns a handgun. Which instructions should the nurse include? Select all that apply.

  1. Use an infant bath seat so you can step away briefly to get a towel
  2. Store the handgun unloaded in a locked box, with the ammunition locked away separately
  3. Set the water heater to 120°F (49°C) or lower
  4. Install window guards on the apartment's windows
  5. Move cleaning products to a high shelf; a lock is not needed once they are out of reach
Show the answer and rationale

Answer: B, C, D

A water heater set at 120°F (49°C) or lower lowers the risk of scalds from tap water, window guards keep a climbing child from falling out of an upper-floor window, and a firearm is stored locked and unloaded, with the ammunition locked separately. A bath seat is not a safety device: an infant can tip over or slip out and slide under the water quickly and silently, so a child in water is never left alone, even to grab a towel. Medicines and cleaning products are kept both up high and locked, because a child who is pulling to stand will soon be climbing.

📚 Learn it: Car Seats, Choking Foods, Safe Sleep and Hospitalized Kids

Question 15 of 20

A 3-year-old is brought to the clinic for constipation that the parents say has been a problem since birth. The child's weight has dropped from the 25th to the 5th percentile, and the abdomen is distended. Which finding in the history most strongly suggests Hirschsprung disease rather than functional constipation?

  1. He hides behind the couch and crosses his legs when he needs to stool
  2. He did not pass his first stool until he was 3 days old
  3. His stools are so large and hard that they have clogged the toilet
  4. His stools became harder after he switched to whole milk at 12 months
Show the answer and rationale

Answer: B

In Hirschsprung disease the end of the colon lacks nerve cells and cannot relax, so stool is held back from birth: most newborns pass meconium within 24 to 48 hours, and a later first stool is the classic early clue, followed by chronic constipation, ribbon-like stools, distension and poor growth. Large, hard stools that clog the toilet are the strongest distractor because they sound severe, but they come from stool held in a large, normally innervated rectum, the opposite of the narrow, ribbon-like stools of Hirschsprung disease. Hiding and leg-crossing are withholding behaviors, and hard stools after starting cow's milk point to diet; both fit functional constipation.

📚 Learn it: Olive, Currant Jelly, Ribbon: The GI Clues

Question 16 of 20

At a well visit for a 14-year-old client, the nurse explains that part of the visit will be spent with the teen alone. The parent says, 'I'm her mother. I have a right to hear everything she says.' Which response by the nurse is best?

  1. 'Since she's a minor, you may stay, and we'll save the private questions for another visit.'
  2. 'Time alone is routine at her age. We'll encourage her to talk with you, and safety concerns would be shared.'
  3. 'You can wait outside, and afterward I'll go over everything she tells me so you know what's going on.'
  4. 'Let's ask your daughter, right now, whether she would rather have you stay in the room.'
Show the answer and rationale

Answer: B

Spending part of every visit alone with the adolescent, starting in early adolescence, is routine because teens share sexual, substance use and mood concerns honestly only in private; framing it as standard, supporting the teen's communication with her parent and naming the safety limits of confidentiality answers the mother's worry. Asking the daughter sounds respectful, but it puts her on the spot in front of her mother, and few teens will ask a parent to leave. Postponing the questions gives up the private time, and promising to repeat everything breaks the confidentiality the teen relies on.

📚 Learn it: Car Seats, Choking Foods, Safe Sleep and Hospitalized Kids

Question 17 of 20

The parent of a healthy 5-month-old says the baby has started rolling from back to tummy and from tummy to back. Which statement by the parent indicates understanding of the safe sleep teaching?

  1. 'A weighted sleep sack will keep her calm and on her back all night.'
  2. 'I'll still put her down on her back, but if she rolls over on her own, I can leave her that way.'
  3. 'If she falls asleep in the car seat on the way home, I'll let her finish the nap in it so I don't wake her.'
  4. 'I'll keep swaddling her snugly at night so she can't roll onto her tummy.'
Show the answer and rationale

Answer: B

Every sleep starts on the back for the first year, but an infant who rolls both ways on her own can stay in the position she rolls into, as long as the crib holds nothing soft. Swaddling is the runner-up because it sounds protective, but it must stop once an infant starts to roll, since a swaddled infant who ends up on her stomach cannot push up or turn back. Weighted sleep sacks and swaddles are not recommended, and an infant who falls asleep in a car seat outside the car is moved to a firm, flat sleep surface as soon as it is practical.

📚 Learn it: Car Seats, Choking Foods, Safe Sleep and Hospitalized Kids

Question 18 of 20

During a home visit, a nurse notes that a family with an 18-month-old lives in a house built in 1950, and the paint on several windowsills is peeling. Which instruction should the nurse give?

  1. Serve foods rich in iron and calcium to limit the child's lead absorption
  2. Scrape off the peeling paint this weekend and repaint the sills
  3. Vacuum the floors and sills daily with the household vacuum
  4. Wet-mop floors and wipe the sills often, and ask about a lead test
Show the answer and rationale

Answer: D

Homes built before 1978 probably contain lead-based paint, and peeling paint creates lead dust that toddlers swallow through normal hand-to-mouth play, so the nurse teaches wet cleaning of floors and sills and recommends blood lead testing. A diet rich in iron and calcium does reduce lead absorption, but it neither removes the dust nor shows whether the child already has a high level. Dry scraping and an ordinary vacuum put lead dust into the air and spread it through the home; repairs are done by lead-safe certified workers while the child is away.

📚 Learn it: Car Seats, Choking Foods, Safe Sleep and Hospitalized Kids

Question 19 of 20

A parent calls the clinic because a 2-year-old was found holding an open bottle of a grandparent's blood pressure pills. The child is awake and playing normally. What should the nurse tell the parent to do first?

  1. Watch the child closely and call back if symptoms start
  2. Call Poison Control now with the pill bottle in hand
  3. Take the child to the emergency department right away
  4. Count the pills left to see how many are missing
Show the answer and rationale

Answer: B

A possible ingestion in an alert child calls for an immediate call to Poison Control (1-800-222-1222 in the United States) with the container in hand, so a specialist can estimate the dose and decide whether the child must be seen; 911 is called instead if the child becomes drowsy, has a seizure or has trouble breathing. Going straight to the emergency department sounds cautious, but Poison Control can judge within minutes whether the amount could be dangerous, call the hospital ahead, and send the child by ambulance if needed, which is safer than a car ride for a toddler who could develop low blood pressure or a slow heart rate on the way. Counting the pills is done with the specialist on the line, and waiting for symptoms delays care for drugs that can cause dangerous hypotension or bradycardia in a toddler.

📚 Learn it: Car Seats, Choking Foods, Safe Sleep and Hospitalized Kids

Question 20 of 20

A nurse is reviewing formula feeding with the parent of a 1-month-old who is fed powdered formula. Which statement by the parent indicates a need for further teaching?

  1. 'I'll throw out what she leaves in the bottle, even if it's most of it.'
  2. 'I'll give it at room temperature; it doesn't need warming.'
  3. 'I'll add extra water to the powder so the can lasts until payday.'
  4. 'I'll pour in the water first, then add the level scoops.'
Show the answer and rationale

Answer: C

Formula mixed with extra water gives too few calories for growth and too much free water, which can cause dilutional hyponatremia and seizures in a young infant, so formula is always mixed exactly as the label directs, and the nurse connects the family with resources such as WIC. Throwing out a mostly full bottle sounds wasteful, but formula left after a feeding is discarded because bacteria from saliva grow in it. The CDC advises measuring the water first and then adding the powder, and formula does not need to be warmed before feeding.

📚 Learn it: Car Seats, Choking Foods, Safe Sleep and Hospitalized Kids

Practice 10 more Pediatrics questions free →

A timed or tutor-mode set in the app, scored by area, with every miss saved for review. Free, no sign-up needed.

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