Pediatrics NCLEX Practice Questions

Key milestones: 2 months — social smile; 6 months — sits with support, rolls over; 9 months — stands with support; 12 months — says 2 words, walks with support; 18 months — 10+ words; 2 years — 2-word phrases, runs. Absence of expected milestones (e.g., no babbling by 12 months) is a red flag requiring follow-up referral.

Epiglottitis: acute onset, drooling, tripod position, "hot potato voice" — true airway emergency, do NOT examine the throat, keep calm, have resuscitation equipment. Croup: barking cough, subglottic swelling, low-grade fever — cool mist and nebulized racemic epinephrine. RSV bronchiolitis: contact precautions required.

Always verify the safe dose range (mg/kg/dose or mg/kg/day) before administering any medication to a child. Calculate: child weight in kg x prescribed mg/kg = safe dose. Compare to the ordered dose — if it exceeds the safe range, hold the medication and notify the provider. NCLEX expects you to recognize unsafe doses and refuse to administer them. Common conversions: 1 kg = 2.2 lbs. Round pediatric doses carefully and always double-check with a second nurse for high-alert medications.

Acyanotic defects (left-to-right shunt, increased pulmonary blood flow): VSD, ASD, PDA — signs include heart failure symptoms, frequent respiratory infections, and failure to thrive. Cyanotic defects (right-to-left shunt, decreased pulmonary blood flow): Tetralogy of Fallot (most common cyanotic defect) — tet spells treated by placing the child in knee-to-chest position to increase systemic vascular resistance. Transposition of the great arteries requires prostaglandin E1 to maintain the ductus arteriosus open until surgical repair.

Live vaccines (MMR, varicella, rotavirus, live influenza nasal spray) are contraindicated in immunocompromised children and during pregnancy. Severe allergic reaction (anaphylaxis) to a previous dose or vaccine component is an absolute contraindication. Mild illness with low-grade fever is NOT a contraindication — educate parents accordingly. Egg allergy is no longer a contraindication for most influenza vaccines. Document all vaccinations given, lot numbers, and any adverse reactions.

Red flags: injuries inconsistent with the developmental stage or stated mechanism, multiple injuries in various stages of healing, burns with clear demarcation lines (stocking or glove pattern), spiral fractures in non-ambulatory children, delay in seeking medical care, and inconsistent histories from caregivers. Nurses are mandated reporters — report suspected abuse to child protective services regardless of certainty. Document findings objectively (exact quotes, injury descriptions, body diagrams) without subjective interpretation.