290 Pediatrics questions written for the NCLEX-RN, each with a rationale explaining why the correct answer is correct and why the others are not. Free, no account required. 10 examples are shown below.
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The answer: A — Viral croup (laryngotracheobronchitis) Think of it this way: Viral croup is the classic 'barky cough' illness in young children — the cough sounds exactly like a seal bark, and you can hear the child straining to breathe in (inspiratory stridor). It follows a day or two of runny nose and mild fever (the viral prodrome), and it's almost always caused by parainfluenza virus. The airways swell from the vocal cords down through the trachea and bronchi — the narrowing is worst just below the vocal cords (subglottic), which is what creates that distinctive high-pitched sound on inhalation. Why A is right: Laryngotracheobronchitis (viral croup) presents with: preceding 1-2 days of upper respiratory symptoms (runny nose, mild fever), followed by the classic harsh barky cough (like a seal), inspiratory stridor (high-pitched noise on breathing in from subglottic narrowing), hoarseness, and symptoms that worsen at night and with agitation. It is the most common cause of acute upper airway obstruction in children aged 6 months to 3 years, predominantly caused by parainfluenza virus type 1. Why the others are wrong: - B: Bacterial tracheitis — presents similarly but patient appears much sicker (toxic, high fever >39°C, does NOT respond to croup treatments like racemic epinephrine or dexamethasone). May require endotracheal intubation. Less common and more severe. - C: Foreign body aspiration — typically sudden onset in a previously well child, no viral prodrome, no fever, may have witnessed choking event. Stridor may be present if the object is in the laryngeal/tracheal area. - D: Anaphylactic reaction — rapid onset after allergen exposure, involves systemic symptoms (urticaria, angioedema, hypotension), no viral prodrome, typically not associated with the barky cough characteristic of croup. Remember: Viral croup = barky/seal cough + inspiratory stridor + viral prodrome in child < 5 years. Mild: treat with cool/humidified air, reassurance; moderate-severe: racemic epinephrine via nebulizer + oral dexamethasone (single dose, long-lasting anti-inflammatory). Watch for accessory muscle use, cyanosis, inability to swallow → worsening obstruction. Technical note: The classic croup score (Westley score) assesses: stridor, retractions, air entry, cyanosis, and level of consciousness. Mild croup (score <3) is treated at home; moderate (3-7) needs corticosteroids and observation; severe (>7) requires racemic epinephrine, steroids, and hospital admission. Heliox (helium-oxygen mixture) may be used in severe cases — it's less dense than air and reduces turbulent airflow through the narrowed larynx.
This child has hyponatremic (sodium 128) and hypokalemic (potassium 3.0) dehydration with lethargy indicating moderate-severe dehydration. The priority is IV fluid therapy with an isotonic solution such as normal saline (0.9% NaCl) or lactated Ringer's; NS is often preferred for hyponatremia. Monitoring for fluid overload is critical during rehydration, especially in young children. Sodium bicarbonate is not indicated and may be harmful in hypokalemia; acidosis typically resolves with fluid resuscitation.
This presentation (poor head control, global hypotonia, feeding difficulties, tongue fasciculations) is classic for spinal muscular atrophy (SMA). Tongue fasciculations are a hallmark of lower motor neuron disease. The confirmatory diagnostic test is genetic testing for SMN1 gene deletion. EMG can show denervation and reinnervation changes but is not the gold standard. CK is elevated in muscular dystrophies, not SMA. MRI might be normal or show atrophy but is not diagnostic.
Vitamin D is essential for calcium absorption in the intestines. Without adequate vitamin D, calcium absorption is impaired, leading to defective mineralization of bones and rickets. The deformities may improve with treatment but won't resolve immediately. Rickets is not primarily a kidney problem (though renal rickets exists) but is most commonly nutritional.
By age 6, most children can tie their shoes (fine motor) and ride a bicycle with training wheels (gross motor), indicating age-appropriate development. School-age children should be developing peer relationships and cooperative play. Buttoning clothes independently is typically achieved by 5-6 years. Understanding time and basic money concepts develops in the school-age years.
Small round magnets pose a serious ingestion hazard for toddlers. If swallowed, magnets can cause intestinal perforation, obstruction, or lead to serious complications. All other options are age-appropriate toys for a 2-year-old.
Environmental modification is the priority intervention to reduce aggressive behaviors. This includes identifying and minimizing triggers, providing calm spaces, using visual schedules, and reducing overwhelming stimuli. Chemical and physical restraints require orders and are not first-line interventions. Gender-based assignments are not appropriate.
Preschoolers (ages 3-6) are in Piaget's preoperational stage and have vivid imaginations. Their egocentric thinking and inability to distinguish fantasy from reality can lead to fears of the dark, monsters, and other imagined threats. This is a normal developmental phenomenon.
Rotavirus and MMR are live vaccines and are contraindicated in infants with suspected or confirmed severe combined immunodeficiency (SCID) or other severe immunodeficiencies. DTaP and IPV are inactivated vaccines and are not contraindicated, though they may be less effective in immunocompromised patients.
Preoperative teaching should include that the hair will be shaved in the surgical area and that frequent neurological assessments will be needed postoperatively. The child may need to keep the head elevated to reduce ICP, not flat. Complete tumor removal cannot be guaranteed and should not be promised to families.
