NCLEX Pediatric Emergencies & Common Conditions questions
The PrepScore bank has 67 Pediatric Emergencies & Common Conditions questions, each with a rationale and two tags: the Client Needs category from the test plan and the clinical judgment step it tests. In this topic the items lean on Take action and Analyze cues, which is worth knowing before you practise it. Three worked samples are below, answers behind a reveal.
Croup vs epiglottitis, pediatric asthma, RSV/bronchiolitis, DKA, febrile seizure, dehydration, sickle cell crisis, lead poisoning, child abuse recognition.
Three worked questions
Q1. A 1-year-old is brought to the ED with concerns for dehydration. The pediatric nurse assesses. Which signs SUGGEST dehydration? Select all that apply.
- A. Sunken anterior fontanelle (below skull contour — moderate-severe)
- B. Dry mucous membranes + decreased tearing
- C. Decreased urine output (< 1 mL/kg/hr) + dry diapers
- D. Tachycardia + delayed capillary refill (> 2 sec) + cool extremities
- E. Decreased skin turgor (tenting)
- F. Bulging fontanelle (OPPOSITE — suggests increased ICP, not dehydration)
Show answer and rationale
Answer: Sunken anterior fontanelle (below skull contour — moderate-severe)Dry mucous membranes + decreased tearingDecreased urine output (< 1 mL/kg/hr) + dry diapersTachycardia + delayed capillary refill (> 2 sec) + cool extremitiesDecreased skin turgor (tenting)
Pediatric dehydration signs: sunken fontanelle + dry mucous membranes + decreased UOP + tachycardia/delayed cap refill + decreased turgor. Bulging suggests ICP.
Q2. A 2-month-old presents for well-child visit. The pediatric nurse reviews CDC immunization schedule. Which vaccines are RECOMMENDED at 2 months? Select all that apply.
- A. DTaP (diphtheria, tetanus, acellular pertussis) — dose 1
- B. Hib (Haemophilus influenzae type b) — dose 1
- C. IPV (inactivated polio) — dose 1
- D. PCV13/PCV15 (pneumococcal conjugate) — dose 1
- E. Rotavirus (oral) — dose 1 + Hepatitis B — dose 2
- F. MMR (measles, mumps, rubella) — given at 12 months, NOT 2 months
Show answer and rationale
Answer: DTaP (diphtheria, tetanus, acellular pertussis) — dose 1Hib (Haemophilus influenzae type b) — dose 1IPV (inactivated polio) — dose 1PCV13/PCV15 (pneumococcal conjugate) — dose 1Rotavirus (oral) — dose 1 + Hepatitis B — dose 2
CDC 2-month vaccines: DTaP + Hib + IPV + PCV13/15 + Rotavirus + HepB. MMR at 12 months.
Q3. A 2-year-old presents with diarrhea and decreased intake. The PED nurse evaluates hydration. Which features indicate MODERATE-SEVERE dehydration? Select all that apply.
- A. Capillary refill > 2 sec
- B. Decreased skin turgor (tenting) + sunken anterior fontanelle
- C. Dry mucous membranes + decreased tears
- D. Decreased urine output (< 1 mL/kg/hr) + dry diapers
- E. Lethargy + altered mental status + cool extremities (severe)
- F. Bulging fontanelle (OPPOSITE — suggests increased ICP)
Show answer and rationale
Answer: Capillary refill > 2 secDecreased skin turgor (tenting) + sunken anterior fontanelleDry mucous membranes + decreased tearsDecreased urine output (< 1 mL/kg/hr) + dry diapersLethargy + altered mental status + cool extremities (severe)
Moderate-severe pediatric dehydration: prolonged cap refill, turgor decreased, sunken fontanelle, dry mucous membranes, decreased tears, decreased UOP, lethargy/AMS, cool extremities. Bulging suggests ICP.
The rules that decide these questions
From the pack's rule cards — the reasoning shortcuts a wrong answer usually means you were missing.
Croup = viral, gradual URI prodrome, barking cough, inspiratory stridor, low-grade fever, child alert. Epiglottitis = bacterial (H. flu), sudden high fever, drooling, tripod position, toxic appearance, often unvaccinated. Treatment: croup = cool mist + nebulized racemic epinephrine + dexamethasone; epiglottitis = NO throat exam, keep upright with parent, immediate OR with anesthesia + ENT.
Wheezing requires air movement. Silent chest = severe obstruction → pre-respiratory failure. Speech limited to 1-2 words + retractions + hypoxia = severe exacerbation. Treatment: O2 + continuous nebulized albuterol + ipratropium + systemic steroids + IV magnesium for severe + anticipate BiPAP / intubation. Educate caregivers that quieter ≠ better in asthma.
RSV bronchiolitis is viral. AAP guidelines: supportive care (O2 if hypoxic, nasal suction, hydration, isolation). Bronchodilators + steroids NOT routinely recommended. Antibiotics only for secondary bacterial infection. Admission criteria: SpO2 < 90%, severe distress, poor feeding/dehydration, apnea, < 3 mo, high-risk comorbidities.
Pediatric DKA differs from adult: SLOWER fluid resuscitation (10-20 mL/kg over 1-2 h, not rapid boluses) to reduce cerebral edema risk. Insulin only after fluid + K+ check (0.05-0.1 unit/kg/hr). Headache + altered LOC + bradycardia/hypertension = cerebral edema warning — emergency mannitol or 3% saline + reduce fluids + ICU. Glucose drop no faster than 100 mg/dL/hr.
Simple febrile seizure: age 6 mo-5 yr, generalized, < 15 min, single in 24 h, postictal recovery, fever > 38°C. Workup based on clinical concern (LP only if meningitis suspected, not routine). Recurrence ~30% but most don't develop epilepsy. MYTH: antipyretics prevent febrile seizures — they don't; use for comfort only. NEVER use bite blocks; lateral position + airway.
Severity: mild (5%) = mild dry mucous membranes, normal LOC, normal cap refill. Moderate (5-10%) = tachycardia, dry, sunken eyes, no tears, decreased urine. Severe (> 10%) = hypotension, lethargic, anuric. ORT (Pedialyte / WHO ORS) preferred for mild-moderate: 5 mL q5 min, build up to 50-100 mL/kg over 4 h. IV bolus 20 mL/kg only for severe or failed ORT. No sports drinks (wrong electrolytes + too much sugar).
Practise the whole pack, tagged and explained
Every item carries its Client Needs category and clinical judgment step, so a wrong answer names the step that failed.
Frequently asked questions
How many Pediatric Emergencies & Common Conditions questions does the bank have?
67 multiple-choice items, plus 10 unfolding cases in the Pediatric Emergencies & Common Conditions pack, each with a rationale.
Are the samples real bank items?
Yes — the three questions above are drawn from the live bank, with their real rationales and tags.
Which clinical judgment steps does this topic train?
Most items in this topic test Take action and Analyze cues, though every step appears.
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