Ten free pediatric (peds) NCLEX practice questions with full rationales — epiglottitis vs croup, RSV, febrile seizures, dehydration, developmental milestones, tet spells, poisoning safety, cystic fibrosis, and sickle cell crisis. Answer each one, then reveal the correct answer and see why every option is right or wrong. No sign-up needed to practice here.
High-Yield Pediatric Review
Pediatric emergencies often hinge on the airway. Epiglottitis is a true airway emergency: a toxic-appearing child with high fever, drooling, dysphagia, a muffled "hot potato" voice, and tripod positioning. Never inspect the throat or use a tongue depressor, and never leave the child alone or agitate them, because these actions can trigger complete laryngospasm and total obstruction. Keep the child calm, upright, and with a caregiver, and prepare for emergency airway management.
Contrast this with croup (laryngotracheobronchitis), a viral illness marked by a barky, seal-like cough and inspiratory stridor. Croup is managed with corticosteroids (dexamethasone 0.6 mg/kg as a single dose) and nebulized racemic epinephrine for moderate-to-severe cases. Keeping the child calm reduces distress. Cool/humidified mist has long been taught as a traditional measure, but it provides no proven clinical benefit and is no longer routinely recommended.
Bronchiolitis, most often from RSV, causes wheezing and distress in infants. Care is supportive (suctioning, hydration, oxygen) with contact precautions. RSV immunoprophylaxis is prevention, not treatment of active bronchiolitis. The current agent is nirsevimab (Beyfortus), a long-acting monoclonal antibody given to infants under 8 months entering their first RSV season who are not already protected by the maternal RSV vaccine; clesrovimab is also available as of 2025. The other option is the maternal RSV vaccine (Abrysvo), given in pregnancy. Palivizumab, the older monthly agent, is no longer available in the U.S. as of December 31, 2025.
Febrile seizures and dehydration are two more high-yield topics. Febrile seizures are usually benign and self-limited. Teach parents to protect the child from injury, turn them to the side, avoid restraining them or placing anything in the mouth, and use antipyretics for comfort. Dehydration assessment includes a sunken fontanel, decreased or absent tears, dry mucous membranes, fewer wet diapers, and prolonged capillary refill, but acute weight loss is the single best indicator of fluid loss. Oral rehydration therapy is first-line for mild-to-moderate dehydration.
Round out your review with development (Erikson's stages and motor/language milestones), congenital heart disease, and safety. In tetralogy of Fallot, a hypercyanotic "tet spell" is treated with a knee-chest or squatting position plus oxygen. For ingestions, call Poison Control and do not induce vomiting; syrup of ipecac is no longer recommended. For acetaminophen overdose, acetylcysteine is the antidote. In a sickle cell vaso-occlusive crisis, prioritize hydration, pain control, and oxygen if hypoxic, and avoid triggers such as cold, dehydration, hypoxia, and infection.
Pediatric (Peds) NCLEX Practice Questions
Question 1 · Epiglottitis (airway emergency)
A 4-year-old is brought to the emergency department with a high fever, drooling, difficulty swallowing, a muffled voice, and is sitting upright leaning forward on both hands. The child appears anxious and is in respiratory distress. Which action should the nurse take FIRST?
- A Keep the child calm with the caregiver present and prepare for emergency airway management
- B Obtain a throat culture with a tongue depressor to identify the causative organism
- C Offer the child oral fluids to bring down the fever and relieve the sore throat
- D Place the child in a supine position and start a rapid IV fluid bolus
Show answer & rationale
Correct answer: A
The presentation of high fever, drooling, dysphagia, a muffled voice, tripod positioning, and distress is classic for epiglottitis, a true airway emergency. Keeping the child calm with the caregiver and preparing for emergency airway management (intubation or tracheostomy at the bedside) is the priority, because any agitation or manipulation can precipitate complete airway obstruction. Obtaining a throat culture with a tongue depressor is contraindicated: touching or visualizing the swollen epiglottis can trigger laryngospasm and total obstruction, so the throat is only examined in a controlled setting where emergency intubation is immediately available. Placing the child supine worsens airway compromise; these children must remain upright. An IV should not be forced first, because painful, frightening procedures can escalate distress and precipitate obstruction. Offering oral fluids is unsafe: the child cannot manage secretions (hence the drooling) and is at high aspiration risk, and fluids delay definitive airway care. Clinical pearl: remember the classic 'Ds' of epiglottitis — Drooling, Dysphagia, Dysphonia (muffled voice), and Distress — and the rule to keep hands out of the mouth. Widespread Hib vaccination has made epiglottitis rare, but it still occurs. The safest approach is to minimize stimulation, provide humidified oxygen if tolerated, and mobilize the team that can secure the airway.
Question 2 · Croup (laryngotracheobronchitis)
A 2-year-old presents with a low-grade fever, a barky, seal-like cough, and inspiratory stridor that worsens when the child cries. The child is alert and drinking. Which management approach does the nurse anticipate?
- A Examine the throat with a tongue depressor and obtain a throat culture before treatment
- B Keep the child NPO and restrict fluids to reduce airway swelling until the stridor resolves
- C Give dexamethasone, keep the child calm, and use racemic epinephrine if stridor worsens
- D Prepare for immediate endotracheal intubation and avoid disturbing the child in any way
Show answer & rationale
Correct answer: C
A barky, seal-like cough with inspiratory stridor and low-grade fever in an alert, well-hydrated toddler is characteristic of viral croup (laryngotracheobronchitis). Standard care centers on corticosteroids (typically dexamethasone) to reduce airway edema and nebulized racemic epinephrine for moderate-to-severe stridor or distress. Cool/humidified mist is a traditional comfort measure that has not been shown to change outcomes. Preparing for immediate intubation is not the anticipated first-line management for typical croup, which is usually managed medically; that level of intervention describes epiglottitis or a child with impending respiratory failure. Examining the throat and obtaining a culture is unnecessary for croup and is specifically avoided when epiglottitis is a concern. Croup is a clinical diagnosis, and the barky cough with stridor is diagnostic. Keeping the child NPO and restricting fluids is inappropriate, since maintaining hydration is important and this child is drinking well; fluid restriction does not reduce airway swelling and only risks dehydration. Clinical pearl: distinguish croup from epiglottitis. Croup has a gradual, viral onset with a barky cough and no drooling, while epiglottitis has an abrupt onset with drooling, dysphagia, muffled voice, and a toxic appearance. Teach parents that cool night air or a steamy bathroom may comfort the child but has not been shown to reduce croup symptoms, and that racemic epinephrine requires observation afterward for rebound stridor.
Question 3 · Febrile seizures (parent teaching)
The nurse is teaching the parents of an 18-month-old who had a simple febrile seizure. Which statement by a parent indicates CORRECT understanding of home management?
- A "I should place a spoon in her mouth during a seizure so she does not bite her tongue."
- B "I should give her aspirin at the first sign of any fever to prevent another seizure."
- C "I need to hold her arms and legs firmly still until the seizure stops."
- D "If she seizes again, I will turn her on her side, keep her safe, and time it."
Show answer & rationale
Correct answer: D
Simple febrile seizures are usually benign and self-limited, and most children outgrow them. Correct home management is to protect the child from injury, turn the child to the side to maintain the airway and allow secretions to drain, avoid restraining the child, and time the seizure so prolonged activity can be reported. Placing a spoon or any object in the mouth is dangerous: it can break teeth, cause aspiration, or obstruct the airway. Nothing should ever be placed in the mouth during a seizure. Holding the arms and legs firmly still (restraining) can cause injury to the child or caregiver and does not stop the seizure; the goal is a safe environment, not immobilization. Giving aspirin is incorrect on two counts. Aspirin is avoided in children because of the risk of Reye syndrome, and antipyretics are used for comfort but have not been shown to prevent febrile seizure recurrence (AAP). Giving aspirin at every fever is therefore both unsafe and ineffective for that purpose. Clinical pearl: reassure parents that a simple febrile seizure does not mean the child has epilepsy or brain damage, and teach them to seek care for seizures lasting more than 5 minutes, focal features, or repeated seizures. Acetaminophen or ibuprofen may be used for fever-related discomfort, and the child should be evaluated to identify the source of the fever.
Question 4 · Developmental milestones (Erikson)
A nurse is caring for a hospitalized 2-year-old. Which intervention BEST supports the child's psychosocial developmental stage according to Erikson?
- A Encourage the toddler to complete self-care tasks alone to build a sense of industry
- B Offer the toddler simple choices, such as which color cup to drink from, to support autonomy
- C Provide detailed verbal explanations of each procedure to build a sense of trust
- D Discourage use of a security blanket so the child learns to be independent
Show answer & rationale
Correct answer: B
According to Erikson, the toddler (roughly 1-3 years) is in the stage of autonomy versus shame and doubt. Offering simple, controlled choices, such as which color cup to use or which arm to use for a blood pressure reading, gives the toddler a sense of control and supports autonomy while still accomplishing care. Encouraging the child to build a sense of 'industry' is incorrect because industry versus inferiority is the stage of the school-age child (about 6-12 years), not the toddler; expecting a 2-year-old to independently complete self-care tasks is developmentally unrealistic. Providing detailed verbal explanations to build 'trust' misapplies the stages: trust versus mistrust is the infant's stage (birth to about 1 year), and lengthy explanations exceed a toddler's cognitive and language level. Brief, concrete explanations just before a procedure work better. Discouraging a security blanket is harmful; transitional (comfort) objects reduce stress and support coping during hospitalization and separation, so they should be encouraged, not removed. Clinical pearl: match interventions to the stage: infancy = trust (consistent, prompt comfort); toddler = autonomy (choices, routines, tolerate negativism); preschooler = initiative (play, simple explanations); school-age = industry (let them help and achieve); adolescent = identity (respect privacy and peer relationships). Preserving routines and rituals and allowing regression during illness are also developmentally appropriate for the hospitalized toddler.
Question 5 · Tetralogy of Fallot (tet spell)
An infant with tetralogy of Fallot suddenly becomes acutely cyanotic, irritable, and increasingly short of breath during feeding. Which action should the nurse take FIRST?
- A Place the infant in a knee-chest position and administer oxygen
- B Encourage the infant to cry vigorously to help expand the lungs
- C Lay the infant flat and administer a rapid IV fluid bolus
- D Perform vigorous chest physiotherapy to loosen secretions
Show answer & rationale
Correct answer: A
This is a hypercyanotic or 'tet' spell, an acute episode of worsening cyanosis in tetralogy of Fallot caused by increased right-to-left shunting. The priority is to place the infant in a knee-chest position (or have an older child squat) and administer oxygen. Flexing the knees to the chest increases systemic vascular resistance, which reduces the right-to-left shunt and improves pulmonary blood flow and oxygenation. Laying the infant flat does not increase systemic resistance and would not relieve the shunt. A fluid bolus is not the first, definitive maneuver, although calming measures and further interventions (such as morphine and, if needed, other agents) may follow. Vigorous chest physiotherapy does nothing to address the shunt physiology, increases oxygen demand, and agitates the infant, which worsens the spell. Encouraging the infant to cry is directly harmful: crying increases agitation, oxygen consumption, and shunting, which deepens the cyanosis. The goal is to keep the infant calm. Clinical pearl: tetralogy of Fallot involves four defects (pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy) and is a cyanotic (right-to-left shunt) lesion. Toddlers instinctively squat during spells, which mimics the knee-chest position. Remember the calm, comfort, knee-chest, and oxygen sequence, and keep the infant with the caregiver to minimize distress.
Question 6 · Poisoning / acetaminophen overdose
A parent calls the nurse line because a 3-year-old was found with an open bottle of acetaminophen and may have swallowed several tablets. The child is currently alert. Which instruction is MOST appropriate?
- A Wait at least 24 hours before seeking care since symptoms are delayed
- B Administer naloxone at home as the antidote for this ingestion
- C Give syrup of ipecac immediately to make the child vomit the tablets
- D Call Poison Control now; acetylcysteine is the specific antidote
Show answer & rationale
Correct answer: D
For any ingestion, the parent should call Poison Control (in the U.S., 1-800-222-1222) immediately for guidance and be prepared to seek emergency care. For acetaminophen toxicity, the specific antidote is acetylcysteine (N-acetylcysteine), which is most effective when given early to prevent hepatotoxicity. Inducing vomiting with syrup of ipecac is no longer recommended and can be harmful: it delays definitive care, risks aspiration, and does not reliably remove the drug. Professional organizations have moved away from ipecac. Advising the family to wait 24 hours is dangerous because acetaminophen toxicity is notorious for a deceptively quiet early phase. Serum acetaminophen levels (interpreted with the Rumack-Matthew nomogram, typically drawn around 4 hours post-ingestion) plus timely acetylcysteine are what prevent liver failure, so evaluation should not be delayed. Naloxone is the antidote for opioid overdose, not acetaminophen, so it is the wrong drug. Clinical pearl: acetaminophen is a leading cause of pediatric medication poisoning, and its antidote is acetylcysteine. Opioids reverse with naloxone, benzodiazepines with flumazenil, and iron with deferoxamine. Prevention teaching is key: store medicines in child-resistant containers up and out of reach, use the dosing device that comes with the product, and keep the Poison Control number visible.
Question 7 · Cystic fibrosis (nutrition and airway clearance)
The nurse is teaching parents of a child newly diagnosed with cystic fibrosis. Which statement indicates that teaching has been effective?
- A "I will avoid chest physiotherapy because it makes him cough up thick mucus."
- B "I will give the pancreatic enzymes only once a day at bedtime, on an empty stomach."
- C "I will give enzymes with every meal and snack and add extra calories and protein."
- D "I will limit calories and fat in his diet so that he does not gain too much weight."
Show answer & rationale
Correct answer: C
Cystic fibrosis causes thick secretions that block the pancreatic ducts, leading to malabsorption of fats and fat-soluble vitamins, and it thickens airway mucus. Correct management includes giving pancreatic enzyme replacement with every meal and snack so the child can absorb nutrients, and providing a high-calorie, high-protein diet (with fat-soluble vitamin supplementation) to meet increased energy needs. Giving enzymes only once daily at bedtime is wrong because enzymes must be taken with food to aid digestion of each meal and snack; timing them away from food defeats their purpose. Limiting calories and fat is incorrect and harmful: children with cystic fibrosis need extra calories and generally do not require fat restriction. Malabsorption and chronic infection increase their caloric demands, and they are at risk for poor growth. Avoiding chest physiotherapy is incorrect: airway clearance techniques (chest physiotherapy, positive expiratory pressure devices, or a high-frequency chest wall oscillation vest) are essential to mobilize thick mucus, and coughing productively is the desired outcome, not a reason to stop. Clinical pearl: think 'enzymes with every bite, extra calories, and clear the airway.' Enzyme capsules can be sprinkled on a small amount of soft, non-alkaline food for young children. Adequate salt intake and hydration matter because these children lose excess sodium and chloride in sweat, which underlies the diagnostic sweat chloride test.
Question 8 · Bronchiolitis / RSV
A 6-month-old infant is admitted with RSV bronchiolitis, presenting with wheezing, nasal congestion, and mild respiratory distress. Which nursing interventions are appropriate? Select all that apply.
- A Administer prophylactic antibiotics to treat the viral infection
- B Place the infant on contact precautions
- C Offer small, frequent feedings or provide IV fluids to maintain hydration
- D Give palivizumab now to treat the current active infection
- E Administer supplemental oxygen as ordered for hypoxia
- F Suction the nares to clear secretions and maintain airway patency
Show answer & rationale
Correct answer: B, C, E, F
Bronchiolitis is most commonly caused by respiratory syncytial virus (RSV) and is managed with supportive care. Placing the infant on contact precautions is appropriate because RSV spreads readily via respiratory secretions and contaminated surfaces (droplet precautions are often added), and strict hand hygiene limits spread. Suctioning the nares (bulb or gentle nasopharyngeal suction) clears secretions and improves feeding and breathing, since infants are obligate nose breathers. Supplemental oxygen is given for hypoxia to maintain adequate saturation. Small, frequent feedings or IV fluids maintain hydration, because tachypnea and congestion increase fluid needs and make feeding difficult, and hydration also helps thin secretions. Administering prophylactic antibiotics is not appropriate: RSV is viral, so antibiotics are ineffective and are only used if there is a documented secondary bacterial infection. Giving palivizumab to treat the current infection is incorrect because palivizumab does not treat an established infection. It is a monoclonal antibody that was given as monthly RSV-season prophylaxis to high-risk infants, such as certain preterm infants or those with chronic lung or congenital heart disease. It is also no longer available in the U.S. as of December 31, 2025, having been replaced by nirsevimab or clesrovimab. Clinical pearl: bronchiolitis care is mainly supportive — suction, hydration, oxygen, and respiratory monitoring. Bronchodilators, steroids, and routine antibiotics are generally not recommended. Prevention centers on hand hygiene and RSV immunization: the maternal RSV vaccine in pregnancy or a single dose of nirsevimab or clesrovimab for infants younger than 8 months born during or entering their first RSV season.
Question 9 · Sickle cell vaso-occlusive crisis
A 7-year-old with sickle cell disease is admitted in a vaso-occlusive crisis with severe pain in the arms and legs. Which interventions should the nurse include in the plan of care? Select all that apply.
- A Apply cold compresses to the painful joints
- B Administer prescribed opioid analgesics for pain control
- C Provide supplemental oxygen as ordered
- D Promote rest and treat any underlying infection promptly
- E Restrict fluids to reduce swelling in the extremities
- F Administer IV and oral fluids to promote hydration
Show answer & rationale
Correct answer: B, C, D, F
A vaso-occlusive crisis occurs when sickled red cells obstruct blood flow, causing ischemia and severe pain. Priority care is hydration with IV and oral fluids to reduce blood viscosity and promote circulation, supplemental oxygen to relieve hypoxia (a trigger and consequence of sickling), and adequate pain management, which frequently requires scheduled opioid analgesics for severe crises. Promoting rest reduces oxygen demand, and promptly treating any underlying infection is essential because infection is both a common trigger and a serious risk in these children (many are functionally asplenic). Applying cold compresses is contraindicated: cold causes vasoconstriction, which worsens sickling and pain. Warm compresses are used instead to promote vasodilation and comfort. Restricting fluids is harmful because dehydration is a major trigger for sickling and increases blood viscosity; these children need generous hydration, not fluid restriction. Clinical pearl: remember the crisis triggers as 'cold, dehydration, hypoxia, infection, acidosis, and stress,' and the treatment priorities as 'HOP': Hydration, Oxygen, and Pain control (plus rest and infection prevention). Encourage adequate fluid intake, keep the child warm, ensure vaccinations and any prescribed prophylactic penicillin, and assess pain frequently using an age-appropriate scale, believing the child's report of pain.
Question 10 · Dehydration assessment
The nurse is assessing a 10-month-old infant with a 2-day history of vomiting and diarrhea for signs of dehydration. Which findings support a diagnosis of dehydration? Select all that apply.
- A Increased number of wet diapers
- B Sunken anterior fontanel
- C Bulging fontanel with bounding pulses
- D Dry mucous membranes
- E Absent or decreased tears when crying
- F Prolonged capillary refill
Show answer & rationale
Correct answer: B, D, E, F
Classic signs of dehydration in an infant include a sunken anterior fontanel, decreased or absent tears, dry mucous membranes, and prolonged capillary refill, all reflecting reduced intravascular and interstitial fluid volume. Decreased urine output is also expected, so an increased number of wet diapers is the opposite of what occurs and does not support dehydration. Instead, the nurse would find fewer wet diapers and darker, more concentrated urine. A bulging fontanel with bounding pulses is incorrect: a bulging fontanel suggests increased intracranial pressure or fluid overload, not dehydration, and dehydration typically produces a weak, rapid (thready) pulse rather than a bounding one. Clinical pearl: although these physical findings are important, acute weight loss is the single best indicator of the degree of fluid loss. Because fluid has weight, comparing current weight to a recent baseline quantifies the deficit (roughly, each kilogram lost equals about 1 liter of fluid). For mild-to-moderate dehydration, oral rehydration therapy with an oral rehydration solution is first-line and preferred over IV fluids; IV therapy is reserved for severe dehydration, shock, or inability to tolerate oral intake. Additional signs to monitor include lethargy or irritability, tachycardia, and cool, mottled extremities. Teach caregivers to offer small, frequent amounts of oral rehydration solution and to watch for the number of wet diapers as a practical marker of hydration at home.
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Pediatric NCLEX FAQ
How do I quickly tell epiglottitis apart from croup on the NCLEX?
Look at onset and the airway signs. Epiglottitis is a rapid-onset, toxic-appearing emergency with the classic 'Ds', Drooling, Dysphagia, Dysphonia (muffled voice), and Distress, plus high fever and tripod positioning, and you never put anything in the mouth. Croup has a more gradual, viral onset with a barky, seal-like cough and inspiratory stridor, and the child usually looks less toxic. If the stem emphasizes drooling and a muffled voice with no cough, think epiglottitis; if it emphasizes a barky cough, think croup.
What is the single best indicator of dehydration in a child?
Acute weight loss. Because fluid has weight, comparing the child's current weight to a recent baseline is the most accurate way to estimate the volume deficit. Physical findings like a sunken fontanel, absent tears, dry mucous membranes, fewer wet diapers, and prolonged capillary refill all support the diagnosis, but weight change quantifies it. For mild-to-moderate dehydration, oral rehydration therapy is first-line.
Why is the knee-chest position used during a tet spell?
In a hypercyanotic 'tet' spell (tetralogy of Fallot), deoxygenated blood shunts right-to-left, worsening cyanosis. Flexing the knees to the chest (or squatting in an older child) increases systemic vascular resistance, which decreases the right-to-left shunt and pushes more blood through the lungs, improving oxygenation. Pair it with oxygen and keeping the child calm, since crying and agitation make the spell worse.
Should parents ever induce vomiting after a child swallows something dangerous?
No. Syrup of ipecac is no longer recommended, and inducing vomiting can cause aspiration and delay effective treatment. The correct steps are to call Poison Control (1-800-222-1222 in the U.S.) right away and follow their guidance, and to seek emergency care as directed. Know common antidotes for the exam, acetylcysteine for acetaminophen, naloxone for opioids, and deferoxamine for iron.