2025 NCLEX Pediatrics/ Peds Exam New Latest
Version Actual Practice Exam Best Study Guide
with Questions and Answers
A school-age child with fever and joint pain has just received a diagnosis of rheumatic fever. The
child's parents ask the nurse whether anything could have prevented this disorder. Which
intervention is effective in preventing rheumatic fever?
1. Immunization with the hepatitis B vaccine
2. Isolation of individuals with rheumatic fever
3. Use of prophylactic antibiotics for invasive procedures
4. Early detection and treatment of streptococcal infections ------------- Correct Answer ----------
- 4. Early detection and treatment of streptococcal infections
RATIONALE: Rheumatic fever is a systemic inflammatory disease that follows a group A
streptococcal infection. Therefore, early detection and treatment of streptococcal infections help
prevent the development of rheumatic fever. Hepatitis B vaccine provides immunity against the
hepatitis B virus — not streptococci. Because rheumatic fever isn't contagious, isolation
measures aren't necessary. Prophylactic antibiotics are used before invasive procedures only in
clients with a history of carditis to prevent bacterial endocarditis.
When performing a physical examination on a neonate, the nurse notes low-set ears. What action
should the nurse perform next?
1. Call the pediatrician for an immediate evaluation of the infant.
2. Note the findings in the medical record.
3. Assess the neonate to determine if other apparent abnormalities are present.
4. Order an ultrasound of the head to determine if the brain is normal. ------------- Correct
Answer ----------- 3. Assess the neonate to determine if other apparent abnormalities are present.
RATIONALE: Although low-set ears are an abnormal finding, the presence of this abnormality
by itself isn't cause for immediate concern. The nurse should continue to assess the neonate to
determine if other abnormalities are present. It's appropriate to note the abnormality in the
medical record; however, it's even more important to continue the assessment. It's outside the
scope of nursing practice to order a diagnostic test, such as an ultrasound, and there's no
indication for this test.
A nurse is caring for a family whose infant has anencephaly. The most appropriate nursing
intervention is to:
1. help the family prepare for the infant's imminent death.
2. implement measures to facilitate the attachment process.
3. provide emotional support so the family can adjust to the birth of an infant with health
,problems.
4. prepare the family for the extensive surgical procedures the infant will require. -------------
Correct Answer ----------- 1. help the family prepare for the infant's imminent death.
RATIONALE: Anencephaly is incompatible with life. The nurse should support family members
as they prepare for the infant's imminent death. Facilitating the attachment process, helping the
family to adjust to the infant's problems, and preparing the family for extensive surgical
procedures are inappropriate because the infant can't survive.
A nurse teaches a mother how to provide adequate nutrition for her toddler, who has cerebral
palsy. Which observation indicates that teaching has been effective?
1. The toddler stays neat while eating.
2. The toddler finishes the meal within a specified period of time.
3. The child lies down to rest after eating.
4. The child eats finger foods by himself. ------------- Correct Answer ----------- 4. The child eats
finger foods by himself.
RATIONALE: The child eating finger foods by himself indicates effective teaching because a
child with cerebral palsy should be encouraged to be as independent as possible. Finger foods
allow the toddler to feed himself. Because spasticity affects coordinated chewing and swallowing
as well as the ability to bring food to the mouth, it's difficult for the child with cerebral palsy to
eat neatly. In terms of a specified period of time, the child with cerebral palsy may require more
time to bring food to the mouth; thus, chewing and swallowing shouldn't be rushed. A child
shouldn't lie down to rest after eating because doing so may cause the child to vomit from a
hyperactive gag reflex. Therefore, the child should remain in an upright position after eating to
prevent aspiration and choking.
A nurse is caring for a 5-year-old child who's in the terminal stages of cancer. Which statements
are true? Select all that apply.
1. The parents may be at different stages in dealing with the child's death.
2. The child is thinking about the future and knows he may not be able to participate.
3. The dying child may become clingy and act like a toddler.
4. Whispering in the child's room will help the child to cope.
5. The death of a child may have long-term disruptive effects on the family.
6. The child doesn't fully understand the concept of death. ------------- Correct Answer -----------
1. The parents may be at different stages in dealing with the child's death.
3. The dying child may become clingy and act like a toddler.
5. The death of a child may have long-term disruptive effects on the family.
6. The child doesn't fully understand the concept of death.
RATIONALE: When dealing with a dying child, parents may be at different stages of grief at
different times. The child may regress in his behaviors. The stress of a child's death commonly
results in parents' divorce and behavioral problems in siblings. Preschoolers see death as
temporary — a type of sleep or separation. They recognize the word "dead" but don't fully
,understand its meaning. Thinking about the future is typical of an adolescent facing death, not a
preschooler. Whispering in front of the child would likely increase his fear of death.
An adolescent with well-controlled type 1 diabetes has assumed complete management of his
disease and wants to participate in gymnastics after school. To ensure safe participation, the
nurse should instruct him to adjust his therapeutic regimen by:
1. eating a snack before each gymnastics practice.
2. measuring his urine glucose level before each gymnastics practice.
3. measuring his blood glucose level after each gymnastics practice.
4. increasing his morning dosage of intermediate-acting insulin. ------------- Correct Answer ----
------- 1. eating a snack before each gymnastics practice.
RATIONALE: Because exercise decreases the blood glucose level, the nurse should instruct him
to eat a snack before engaging in physical activity to prevent a hypoglycemic episode. Measuring
his urine glucose level before each gymnastics practice is incorrect because the urine glucose
level doesn't reflect the current blood glucose level. To prevent hypoglycemia, the blood glucose
level should be measured before the activity, not after the activity. Increasing his morning dosage
of intermediate-acting insulin may lead to hypoglycemia during gymnastics practice; to avoid
this condition, the adolescent may need to decrease, not increase, his morning dosage of
intermediate-acting insulin.
A 16-year-old girl visits the clinic for the first time. She tells the nurse that she has been exposed
to herpes. Initially, with primary genital or Type 2 herpes simplex, the nurse should expect the
girl to have:
1. dysuria and urine retention.
2. perineal ulcers and erosions.
3. bilateral inguinal lymphadenopathy.
4. burning or tingling on vulva, perineum, or vagina. ------------- Correct Answer ----------- 4.
burning or tingling on vulva, perineum, or vagina.
RATIONALE: Genital burning and tingling is the most common initial finding with primary
genital or Type 2 herpes simplex. This symptom will advance to vesicular lesions rupturing into
ulcerations, which then dry into a crusty erosion. Fever, headache, malaise, myalgia, regional
lymphadenopathy, and dysuria, and urine retention are later findings in Type 2 herpes.
Which situation violates a hospitalized adolescent's right to confidentiality?
1. Two nurses talk about the adolescent on an elevator on their way to lunch.
2. The adolescent talks about his disease to someone in the hallway.
3. A physician discusses treatment plans with the adolescent in his mother's presence.
4. A physician discusses a new medication for the adolescent while on the phone with the
pharmacist. ------------- Correct Answer ----------- 1. Two nurses talk about the adolescent on an
elevator on their way to lunch.
, RATIONALE: The elevator isn't a secure area in which to talk about any client, including an
adolescent; anyone could overhear the nurses' conversation. A client isn't breaching his own
confidentiality if he volunteers information about himself. When a client is present for the
conversation, he can object at any time to the content of the conversation. Physicians and other
health care providers are expected to discuss clients and cases, as long as they do so within the
context of a professional relationship and the discussion is necessary for the course of treatment.
A 3-year-old Vietnamese child with a fever, decreased urine output, wheezing, and coughing is
brought to the emergency department. On examination, the nurse discovers red, round, weltlike
lesions on the child's upper back and chest. The nurse should consider that these lesions may be
caused by:
1. shingles.
2. child abuse.
3. allergic reaction.
4. cultural practice. ------------- Correct Answer ----------- 4. cultural practice.
RATIONALE: The nurse should consider that the lesions may be caused by cultural practice.
Many Vietnamese perform coining, a cultural practice in which a coin is repeatedly rubbed
lengthwise on the oiled skin to rid the body of a disease. Coining can produce weltlike lesions on
the child's back or chest, and children subjected to the practice are commonly thought to have
been abused. Interviewing the family and assessing its cultural background help distinguish
between abuse and culture practice. Shingles, a form of herpes zoster, is a communicable disease
usually affecting immunocompromised individuals and older adults. The disease produces small
crusty pustules on the lower back and trunk. The description of the lesions doesn't fit those
produced by an allergic reaction.
At a previous visit, the parents of an infant with cystic fibrosis received instruction in the
administration of pancrelipase (Pancrease). At a follow-up visit, which finding in the infant
suggests that the parents require more teaching about administering the pancreatic enzymes?
1. Fatty stools
2. Liquid stools
3. Bloody stools
4. Normal stools ------------- Correct Answer ----------- 1. Fatty stools
RATIONALE: Pancreatic enzymes normally aid in food digestion in the intestine. In a child with
cystic fibrosis, however, these natural enzymes cannot reach the intestine because mucus blocks
the pancreatic duct. Without these enzymes, undigested fats and proteins produce fatty stools. If
the parents were administering the pancreatic enzymes correctly, the child would have stools of
normal consistency. Noncompliance doesn't cause liquid or bloody stools.
A toddler is having a tonic-clonic seizure. What should the nurse do first?
1. Restrain the child.
2. Place a tongue blade in the child's mouth.
