Common Pediatric Disorders — NCLEX Nursing Lesson Pediatric Nursing · RN Track · Nursing Care of Children · Conditions · Common Pediatric Disorders Condition Lesson · NCLEX-PN / NCLEX-RN

The high-yield childhood conditions—across respiratory, GI, neurologic, endocrine, hematologic, infectious, and congenital systems—that fill NCLEX questions and pediatric units. What goes wrong, why it matters, and how to keep children safe.

Builds on prior lessons This lesson assumes you've completed Pediatric A&P and Pediatric Nursing Care/Assessment. Recall the key threads we'll lean on: children have smaller, more collapsible airways, a higher proportion of body water (dehydrate fast), immature immune and organ systems, and they compensate well then crash suddenly. Here we focus on disease-specific reasoning, not repeating the basics. In this lesson

Lesson Objectives
Why These Diseases Matter
Disease Overview
Pathophysiology
Risk Factors
Signs & Symptoms
Nursing Assessment
Diagnostic Tests
Laboratory Tests
Medications
Nursing Interventions
Complications
Patient Education
Clinical Judgment
Clinical Connections
NCLEX High-Yield Review
Memory Aids
Case Study
Practice Questions
Key Takeaways
References

Lesson Objectives

Recognize the most commonly tested pediatric disorders across seven systems and explain the pathophysiology behind their key signs.
Prioritize care using airway–breathing–circulation and safety, and identify each condition's emergency findings.
Explain why specific assessments, medications, and interventions are used for each disorder.
Distinguish conditions that are commonly confused (e.g., croup vs. epiglottitis, pyloric stenosis vs. intussusception, cyanotic vs. acyanotic defects).
Apply clinical judgment and provide accurate family education for common childhood illnesses.

Why These Diseases Matter

Prevalence: respiratory illness (RSV/bronchiolitis, croup, asthma), gastroenteritis/dehydration, and febrile illnesses are among the most common reasons children are hospitalized. Asthma is the most common chronic childhood disease; type 1 diabetes and sickle cell disease are frequent chronic diagnoses; and congenital heart defects are the most common birth defect.

Patient safety: children's small, collapsible airways make respiratory conditions dangerous fast; their high body-water turnover makes dehydration life-threatening; and several conditions (epiglottitis, DKA, meningitis, sickle cell crisis, Kawasaki) are true emergencies. Missing early cues costs lives.

NCLEX importance: pediatric items test prioritization (which child do you see first?), emergency recognition, do-not-do safety points (never inspect the throat in suspected epiglottitis; never palpate a Wilms tumor), and confusing look-alikes.

Why nurses encounter this often: pediatric, ED, urgent-care, school, and community nurses see these conditions daily—recognizing and responding correctly is core practice.

Disease Overview

This lesson surveys the highest-yield disorders in each system. Each affects normal physiology in a characteristic way:

System	Key disorders	Core disturbance
Respiratory	Bronchiolitis (RSV), croup, epiglottitis, asthma	Airway narrowing/obstruction and impaired gas exchange in small airways
Gastrointestinal	Gastroenteritis/dehydration, pyloric stenosis, intussusception	Fluid/electrolyte loss and/or mechanical obstruction
Neurologic	Febrile seizures, bacterial meningitis	Abnormal neuronal firing / CNS infection & inflammation
Endocrine	Type 1 diabetes / DKA	Absolute insulin deficiency → hyperglycemia & ketoacidosis
Hematologic	Sickle cell disease (vaso-occlusive crisis)	Abnormal hemoglobin → RBC sickling, hemolysis, vaso-occlusion
Infectious	Kawasaki disease	Systemic vasculitis with risk to coronary arteries
Congenital	Acyanotic (VSD, ASD, PDA, coarctation) & cyanotic (Tetralogy of Fallot, transposition) heart defects	Abnormal blood flow/shunting (L→R vs. R→L)

Pathophysiology

Rather than one disease, these share recurring mechanisms. Learn the pattern and the details fall into place.

Respiratory obstruction (bronchiolitis, croup, epiglottitis, asthma)

Normal: air moves freely through open airways; gas exchange oxygenates blood. ↓ What goes wrong: the airway narrows—bronchiolitis (RSV inflames/plugs small bronchioles with mucus), croup (viral swelling of the subglottic larynx), epiglottitis (bacterial swelling of the epiglottis above the cords), asthma (bronchospasm + inflammation + mucus). ↓ Symptoms: because a child's airway is small, a little swelling causes a lot of obstruction → stridor (upper airway: croup/epiglottitis), wheezing (lower airway: bronchiolitis/asthma), retractions, nasal flaring, tachypnea, and hypoxia. ↓ Progression: increasing work of breathing → fatigue → respiratory failure. A quiet chest or a tiring child is ominous—they're running out of reserve. Analogy — a straw vs. a garden hose A child's airway is like a coffee straw; an adult's is like a garden hose. A millimeter of swelling barely dents the hose but can nearly close the straw. That geometry (resistance rises steeply as the radius shrinks) is why the same infection that gives an adult a scratchy throat gives a toddler stridor and distress.

Fluid loss & obstruction (GI disorders)

Gastroenteritis: viral infection (often rotavirus/norovirus) → vomiting & diarrhea → fluid and electrolyte loss → dehydration (children's higher water turnover makes this fast). ↓ Pyloric stenosis: the pyloric muscle hypertrophies and blocks gastric outflow → projectile non-bilious vomiting in a hungry infant (2–8 weeks) → loss of stomach acid → hypochloremic, hypokalemic metabolic alkalosis and dehydration. ↓ Intussusception: one segment of bowel telescopes into another → obstruction & ischemia → severe intermittent (colicky) pain, a "sausage-shaped" mass, and classic "currant jelly" (blood + mucus) stools. An emergency—bowel can necrose.

Neurologic (febrile seizures, meningitis)

Febrile seizures: a rapid rise in temperature (often 6 months–5 years) lowers the seizure threshold in an immature brain → a brief, generalized seizure. Usually benign, but frightening for families. Bacterial meningitis: pathogens inflame the meninges → fever, nuchal rigidity, headache, photophobia, altered mental status; in infants, a bulging fontanel and high-pitched cry. It can progress to increased ICP and shock—an emergency.

Endocrine (Type 1 DM / DKA)

Autoimmune destruction of pancreatic beta cells → absolute insulin deficiency. Without insulin, cells can't use glucose → hyperglycemia (osmotic diuresis → polyuria, polydipsia, dehydration) and the body burns fat → ketones → metabolic acidosis (DKA): Kussmaul (deep, rapid) breathing, fruity breath, abdominal pain, and altered consciousness.

Hematologic (sickle cell)

Inherited hemoglobin S → under stress (hypoxia, dehydration, infection, cold, acidosis) RBCs sickle, becoming rigid and sticky → vaso-occlusion (pain crisis, organ ischemia) and hemolysis (anemia). Explains the pain, the triggers, and why hydration and oxygenation are central to care.

Infectious (Kawasaki disease)

A systemic vasculitis of unknown cause in young children → prolonged fever + mucocutaneous inflammation. The danger: it can inflame the coronary arteries → aneurysms, so timely treatment protects the heart.

Congenital heart defects (shunting)

Acyanotic (VSD, ASD, PDA): blood shunts left→right (oxygenated blood recirculates through lungs) → increased pulmonary flow, risk of heart failure. Cyanotic (Tetralogy of Fallot, transposition): blood shunts right→left (deoxygenated blood reaches the body) → cyanosis despite oxygen. This L→R vs. R→L distinction predicts the presentation.

Risk Factors

Category	Examples
Non-modifiable	Young age (small airways, immature immunity); prematurity; genetics (sickle cell, T1DM predisposition, congenital defects); family history
Modifiable	Tobacco smoke exposure (asthma/respiratory illness); dehydration risk with poor fluid intake; asthma trigger exposure; poor glycemic control; missed prophylaxis
Preventable	Vaccine-preventable disease (Hib → epiglottitis/meningitis; pneumococcal/meningococcal; influenza); RSV prevention (immunoprophylaxis for high-risk infants); hand hygiene to limit GI/viral spread
High-risk populations	Infants & young children; premature or chronically ill children; unimmunized children; children with congenital heart disease or sickle cell disease (infection/crisis risk)

Why immunization is the through-line Widespread Hib vaccination made epiglottitis rare—so an unimmunized child with drooling, tripod posture, and stridor should raise it immediately. Vaccination status shapes your differential and your teaching.

Signs & Symptoms

Condition	Early / expected	Late / emergency (WHY)
Bronchiolitis (RSV)	Coryza, cough, low-grade fever, wheezing, tachypnea	Retractions, nasal flaring, apnea (infants), hypoxia — small airways plug and fatigue sets in
Croup	Barky "seal" cough, hoarseness, inspiratory stridor worse at night	Stridor at rest, retractions, cyanosis, drooling — worsening subglottic swelling
Epiglottitis	Sudden high fever, sore throat, muffled voice	4 D's: Drooling, Dysphagia, Dysphonia, Distress + tripod position — swollen epiglottis obstructs airway; do NOT inspect throat
Asthma	Wheezing, cough, chest tightness, prolonged expiration	Silent chest, retractions, inability to speak, cyanosis — severe obstruction/air trapping = impending failure
Gastroenteritis	Vomiting, diarrhea, decreased intake	Signs of dehydration/shock: lethargy, sunken fontanel, tenting, minimal urine, tachycardia
Pyloric stenosis	Progressive projectile, non-bilious vomiting; hungry after; palpable "olive"	Dehydration, weight loss, metabolic alkalosis
Intussusception	Sudden colicky pain, drawing legs up, vomiting	"Currant jelly" stools, sausage-shaped mass, lethargy — bowel ischemia
Febrile seizure	Brief generalized seizure with rapid fever rise	Prolonged (>5 min) or focal seizure, or in an ill-appearing child — rule out meningitis
Meningitis	Fever, headache, irritability, poor feeding (infant)	Nuchal rigidity, photophobia, altered LOC, bulging fontanel, petechial rash (meningococcal) — ICP/sepsis
DKA	Polyuria, polydipsia, weight loss, fatigue	Kussmaul breathing, fruity breath, abdominal pain, altered LOC — acidosis & dehydration
Sickle cell crisis	Pain (bones/joints/abdomen), pallor, fatigue	Acute chest syndrome (chest pain, hypoxia), stroke signs, splenic sequestration, priapism
Kawasaki	Fever ≥5 days + rash, conjunctivitis, red cracked lips/strawberry tongue, extremity changes, lymphadenopathy	Coronary artery aneurysm, cardiac ischemia
Congenital heart defect	Murmur, poor feeding, poor weight gain, tachypnea; cyanosis (cyanotic type)	Heart failure signs; "tet spells" (hypercyanotic episodes) — knee-to-chest positioning

Nursing Assessment

Subjective

Onset/duration, feeding & wet diapers (hydration), fever pattern, immunization status, exposures/sick contacts, family history (sickle cell, cardiac), and for chronic conditions, home management and adherence.

Objective

General impression (sick vs. not sick), work of breathing (retractions, flaring, grunting, stridor vs. wheeze), age-based vital signs and SpO₂, hydration signs, neuro status/LOC, and skin (color, rash, perfusion).

Priority / red flags — notify provider & act immediately

Airway: stridor at rest, drooling + tripod (epiglottitis — keep child calm, do NOT examine throat or use tongue blade), silent chest in asthma.
Breathing: severe retractions, grunting, apnea, SpO₂ falling, a tiring child.
Circulation/neuro: signs of shock/severe dehydration, altered LOC, bulging fontanel, petechial/purpuric rash, Kussmaul breathing.
Do-not-do safety: never palpate the abdomen of a suspected Wilms tumor; never inspect the throat in suspected epiglottitis.

Diagnostic Tests

Test	Purpose / why ordered	Findings & nursing considerations
Pulse oximetry / ABG	Assess oxygenation & acid–base (respiratory illness, DKA)	Hypoxia in respiratory disease; metabolic acidosis in DKA. Continuous SpO₂ monitoring; teach families about home pulse ox if used.
Chest/neck X-ray	Croup vs. other causes; pneumonia; cardiac size	Croup → subglottic "steak/steeple sign"; epiglottitis → "thumbprint sign" (only if airway secured). Never delay airway care for imaging.
Rapid viral testing (RSV, influenza)	Identify pathogen; guide isolation/cohorting	Nasopharyngeal swab; institute contact/droplet precautions.
Abdominal ultrasound	Pyloric stenosis (thickened pylorus), intussusception ("target sign")	Non-invasive; prepare/comfort child.
Air/contrast enema	Intussusception — diagnostic AND therapeutic (can reduce it)	Monitor for recurrence; a normal brown stool suggests reduction. Watch for perforation signs.
Lumbar puncture	Diagnose meningitis (CSF analysis)	Position & comfort child; monitor site; give antibiotics promptly—do not delay for LP if bacterial meningitis is suspected.
Echocardiogram	Define congenital defects; monitor coronary arteries in Kawasaki	Non-invasive; keep child calm/still (may need sedation).

Laboratory Tests

Lab	Relevant to	Expected findings & significance
Serum electrolytes	Gastroenteritis, pyloric stenosis, DKA	Pyloric stenosis → ↓Cl, ↓K, metabolic alkalosis; DKA → ↑glucose, ↓HCO₃, variable K (correct before insulin drives it into cells). Trend closely.
Blood glucose & ketones	Type 1 DM / DKA	Marked hyperglycemia + ketones/acidosis = DKA. Monitor glucose hourly on insulin drip; watch for hypoglycemia and hypokalemia.
ABG / venous blood gas	DKA, respiratory failure	DKA → metabolic acidosis (low pH, low HCO₃); respiratory failure → rising CO₂.
CBC	Infection, sickle cell, Kawasaki	↑WBC (bacterial infection); sickle cell → anemia, high reticulocytes; Kawasaki → ↑platelets (thrombocytosis, later) & ↑inflammatory markers.
Inflammatory markers (ESR/CRP)	Kawasaki, meningitis	Elevated—support diagnosis and track response.
CSF analysis	Meningitis	Bacterial → ↑WBC (neutrophils), ↑protein, ↓glucose, cloudy. Viral → milder, normal glucose.
Blood cultures	Sepsis/meningitis	Draw before antibiotics when possible—but never delay antibiotics for a critically ill child.

Medications

Bronchodilators (e.g., albuterol) — asthma

MOA/why: beta-2 agonists relax bronchial smooth muscle → open airways for quick relief. Side effects: tachycardia, tremor, jitteriness. Nursing/teaching: rescue inhaler; use a spacer; monitor HR; teach correct technique and to seek care if not relieved.

Corticosteroids — asthma, croup

MOA/why: reduce airway inflammation/swelling. Croup: dexamethasone shrinks subglottic edema; severe croup: nebulized racemic epinephrine for rapid (temporary) vasoconstriction—observe for rebound. Teaching: complete courses; rinse mouth after inhaled steroids.

Antipyretics/analgesics (acetaminophen, ibuprofen)

Why: fever/pain control (febrile illness, Kawasaki uses high-dose then low-dose aspirin—a key exception to the usual "no aspirin in children/Reye syndrome" rule). Teaching: weight-based dosing, avoid aspirin for viral illness except when specifically ordered (Kawasaki).

Insulin — Type 1 DM / DKA

MOA/why: replaces absolute deficiency; moves glucose into cells and stops ketogenesis. DKA: IV regular insulin drip after starting fluids; correct potassium first/along with insulin (insulin shifts K into cells → hypokalemia). High-alert medication — double-check. Teaching: injection technique, rotation, hypoglycemia signs/treatment.

Antibiotics — bacterial meningitis, epiglottitis

Why: treat bacterial infection; give promptly—early antibiotics save lives in meningitis. Nursing: droplet precautions for meningococcal/Hib; monitor for allergy; ensure cultures when feasible.

IVIG + aspirin — Kawasaki disease

Why: IVIG reduces inflammation and lowers the risk of coronary aneurysms; aspirin for anti-inflammatory/antiplatelet effect. Nursing: monitor cardiac status/echo; delay live vaccines after IVIG.

Sickle cell crisis — hydration, oxygen, analgesia, hydroxyurea

Why: IV fluids and oxygen reduce sickling; opioids manage severe pain (pain is real—treat it); hydroxyurea raises fetal hemoglobin to reduce crises. Nursing: pain is the priority symptom; avoid cold, ensure hydration; monitor for acute chest syndrome.

NCLEX pearl — high-alert & the aspirin exception Insulin is high-alert—double-check and address potassium in DKA. Aspirin is normally avoided in children (Reye syndrome) except in Kawasaki disease, where it's part of standard therapy.

Nursing Interventions

Airway (first): keep the child calm (agitation worsens obstruction); do NOT examine the throat in suspected epiglottitis; position for comfort (let croup/epiglottitis child sit up; knee-to-chest for a tet spell). Why: a patent airway comes before everything. ↓ Breathing: humidified/oxygen as ordered, elevate head, suction the infant's nose in bronchiolitis, give bronchodilators/steroids. Why: improve gas exchange and reduce work of breathing. ↓ Circulation/fluids: IV fluids for dehydration/DKA/sickle crisis; monitor I&O, weight, and electrolytes. Why: restore volume/perfusion and correct imbalances. ↓ Safety: seizure precautions (febrile seizure/meningitis), isolation precautions (RSV/meningitis), fall/injury prevention, high-alert med double-checks. Why: prevent harm. ↓ Comfort/atraumatic care: treat pain (sickle cell), reduce fear with distraction and parental presence, cluster care to allow rest. Why: children heal better when calm and comfortable. ↓ Education & interdisciplinary care: teach families; involve respiratory therapy, dietitians (diabetes), and specialists (cardiology/hematology). Why: safe home management and follow-up.

Potential Complications

Complication	Early signs	Nursing/emergency response
Respiratory failure (bronchiolitis, croup, asthma)	Rising RR then falling, fatigue, silent chest, dropping SpO₂	Oxygen, prepare for advanced airway, notify provider/rapid response.
Airway obstruction (epiglottitis)	Increasing stridor, drooling, distress	Keep calm, do NOT examine throat; have airway equipment ready; ENT/anesthesia.
Hypovolemic shock (gastroenteritis, DKA)	Tachycardia, delayed cap refill, minimal urine, altered LOC	IV isotonic bolus, monitor, notify provider.
Cerebral edema (DKA)	Headache, altered LOC, bradycardia during treatment	Slow correction of glucose/fluids per protocol; emergency response.
Acute chest syndrome/stroke (sickle cell)	Chest pain, hypoxia, neuro changes	Oxygen, hydration, analgesia, transfusion per orders; emergency.
Coronary aneurysm (Kawasaki)	Cardiac symptoms; echo changes	Timely IVIG/aspirin; cardiology follow-up.
Heart failure (acyanotic defects)	Poor feeding, tachypnea, sweating, poor weight gain	Feeding support, monitor, medications per orders.

Patient Education

Disease process & home care: explain the condition in plain terms; teach hydration and small frequent feeds for GI illness; nasal suctioning for bronchiolitis; cool-mist/calm for croup; trigger avoidance and inhaler/spacer technique for asthma.

Medication adherence: weight-based dosing, insulin technique/hypoglycemia treatment, finishing antibiotics, and asthma controller vs. rescue medications.

Warning signs / when to seek emergency care: trouble breathing, stridor at rest, blue color, no wet diapers/signs of dehydration, a seizure lasting >5 minutes, a stiff neck with fever, altered consciousness, or uncontrolled pain.

Follow-up & prevention: immunizations, RSV prevention for high-risk infants, diabetes and sickle cell clinic follow-up, cardiology for heart defects, and hand hygiene to limit spread.

Clinical Judgment (NCSBN Model)

A 3-year-old is brought in with a 5-day high fever, red cracked lips, a rash, red eyes, and swollen hands. The parent reports the child is very irritable.

Recognize cues

Fever ≥5 days plus conjunctivitis, mucosal changes (red/cracked lips, strawberry tongue), rash, and extremity changes—classic Kawasaki disease features.

Analyze cues

This clinical picture suggests systemic vasculitis with a real risk to the coronary arteries; inflammatory markers and platelets are likely elevated.

Prioritize hypotheses

Priority concern: coronary artery involvement. Timely treatment reduces aneurysm risk.

Generate solutions

Anticipate IVIG and aspirin, baseline/serial echocardiogram, fever/comfort management, and monitoring cardiac status.

Take action

Administer IVIG/aspirin as ordered, monitor for reactions and cardiac symptoms, provide atraumatic care, and educate the family (including delaying live vaccines after IVIG).

Evaluate outcomes

Success = fever resolves, inflammation improves, and echo shows no/limited coronary changes. Ensure cardiology follow-up.

Clinical Connections — Commonly Confused

	Croup	Epiglottitis
Cause	Viral (parainfluenza)	Bacterial (classically Hib)
Onset/assessment	Gradual; barky cough, stridor, low fever	Sudden; high fever, drooling, dysphagia, muffled voice, tripod
Diagnostics	"Steeple sign" on X-ray	"Thumbprint sign" (only after airway secured)
Treatment	Cool mist, dexamethasone, racemic epi if severe	Secure airway, IV antibiotics — do NOT examine throat
Priority nursing	Keep calm, monitor airway	Emergency airway readiness; keep calm; no tongue blade

	Pyloric stenosis	Intussusception
Cause	Hypertrophied pyloric muscle	Bowel telescopes into itself
Age/assessment	2–8 wk; projectile non-bilious vomiting, hungry, "olive"	3 mo–3 yr; colicky pain, drawing up legs, currant jelly stool
Diagnostics	Ultrasound (thick pylorus)	Ultrasound ("target"); air/contrast enema (also treats)
Treatment	Correct fluids/electrolytes → pyloromyotomy	Enema reduction; surgery if needed
Priority nursing	Rehydrate, correct alkalosis, monitor	Monitor for perforation/recurrence; NPO, IV fluids

	Acyanotic defects (VSD, ASD, PDA)	Cyanotic defects (TOF, transposition)
Shunt	Left → right	Right → left
Assessment	Murmur, HF signs, poor weight gain; usually pink	Cyanosis, "tet spells," clubbing
Priority nursing	Feeding support, monitor for HF	Knee-to-chest for tet spell, oxygen, calm; surgical repair

NCLEX High-Yield Review

What the NCLEX Wants You to Know

Epiglottitis = 4 D's + tripod → do NOT inspect the throat; keep calm; airway ready
Stridor = upper airway (croup/epiglottitis); wheeze = lower airway (bronchiolitis/asthma)
Silent chest in asthma = emergency, not improvement
Pyloric stenosis = projectile non-bilious vomiting + hypochloremic hypokalemic alkalosis
Intussusception = currant jelly stool + sausage mass + colicky pain
DKA: fluids first, insulin drip, watch/replace potassium; guard against cerebral edema
Kawasaki: IVIG + aspirin to protect coronary arteries (aspirin exception)
Sickle cell crisis: hydration, oxygen, pain control; avoid cold/dehydration
Never palpate a suspected Wilms tumor

Common distractors: choosing to "assess the throat" in epiglottitis; reading a silent chest as improvement; giving insulin before fluids/potassium in DKA; avoiding aspirin in Kawasaki. Delegation: the RN performs assessments, administers high-alert meds (insulin), and evaluates; UAP can take vitals, weigh, feed a stable child, count diapers/measure output, and provide hygiene—not assess, medicate, or teach. Prioritization: airway threats and shock come first. Critical labs: potassium in DKA, glucose, electrolytes in vomiting/dehydration, CSF glucose/protein in meningitis. Most common mistakes: using pounds instead of kg, missing early compensation, and confusing look-alike conditions.

Memory Aids

Epiglottitis "4 D's": Drooling, Dysphagia, Dysphonia, Distress (+ tripod). Don't put anything in the throat.
Stridor is high & loud (upper), Wheeze is low (lower): "stridor = subglottic/upper, wheeze = bronchi/lower."
Croup vs. epiglottitis: croup = Cough (barky), Cool mist, Calm; epiglottitis = Emergency airway.
Pyloric stenosis "POM": Projectile vomiting, Olive mass, Metabolic alkalosis.
Intussusception "currant jelly": blood + mucus stool = telescoped bowel.
DKA order "Fluids, Insulin, Potassium": fluids first, insulin drip, watch potassium.
Kawasaki "CRASH and burn": Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hands/feet changes + fever (burn ≥5 days).
Sickle triggers "the cold, dry, tired lungs sickle": hypoxia, dehydration, infection, cold, acidosis.

Case Study

An 8-year-old with type 1 diabetes is brought to the ED with 2 days of vomiting, deep rapid breathing, fruity breath, and confusion. Glucose is 480 mg/dL; the venous gas shows metabolic acidosis; ketones are positive; potassium is 5.4 mEq/L. HR 138, capillary refill 3 seconds, decreased urine output.

Recognize & analyze cues

Hyperglycemia + ketones + acidosis + Kussmaul breathing + dehydration = DKA. The child is dehydrated and acidotic; potassium looks high now but will fall once insulin drives it into cells.

Prioritize & plan

Priority: restore volume and correct acidosis safely. Start IV isotonic fluids first, then an insulin drip, and monitor/replace potassium. Correct glucose slowly to avoid cerebral edema.

Take action

IV fluids, insulin infusion (high-alert—double-check), hourly glucose, continuous cardiac/K monitoring, strict I&O, and neuro checks (watch for headache/altered LOC = cerebral edema).

Evaluate & discharge

Success = closing acid–base gap, glucose trending down safely, improving hydration and LOC, and stable potassium. Before discharge: reinforce sick-day rules, insulin/ketone monitoring, and when to seek care.

NCLEX Practice Questions

Answer choices are numbered; the correct answer is given as a number.

1. A 3-year-old presents with sudden high fever, drooling, muffled voice, and is sitting leaning forward. Which action should the nurse take?

Use a tongue blade to inspect the throat
Lay the child flat for a chest X-ray
Keep the child calm and prepare for emergency airway support
Obtain a throat culture immediately

Rationale

Answer: 3. This is epiglottitis—the priority is a patent airway. Keep the child calm and ready airway support. Inspecting the throat (1) or a throat culture (4) can trigger complete obstruction; laying the child flat (2) worsens obstruction.

2. A child with asthma who was loudly wheezing now has a "silent chest" and is drowsy. The nurse interprets this as:

Impending respiratory failure requiring immediate intervention
Improvement in the asthma attack
A normal response to the bronchodilator
A sign the child is ready for discharge

Rationale

Answer: 1. A silent chest means air isn't moving—severe obstruction and impending respiratory failure, not improvement (2, 3) or readiness for discharge (4). Act immediately.

3. A 4-week-old has progressive projectile, non-bilious vomiting and is hungry after vomiting. The nurse anticipates which acid–base/electrolyte pattern?

Metabolic acidosis with hyperkalemia
Respiratory acidosis with hypernatremia
Respiratory alkalosis with hypercalcemia
Hypochloremic, hypokalemic metabolic alkalosis

Rationale

Answer: 4. Pyloric stenosis causes loss of gastric HCl → hypochloremic, hypokalemic metabolic alkalosis. The other patterns don't fit loss of stomach acid.

4. A child in DKA has a potassium of 5.3 mEq/L. The provider orders IV fluids and an insulin drip. The nurse understands that as insulin is given:

Potassium will rise further and should be restricted
Potassium will shift into cells and may fall, requiring monitoring/replacement
Glucose should be lowered as fast as possible
Sodium bicarbonate is the first priority

Rationale

Answer: 2. Insulin drives potassium into cells, so a "high-normal" K can drop quickly—monitor and replace. Glucose is lowered slowly (3) to avoid cerebral edema; bicarbonate (4) isn't first-line; potassium won't keep rising (1).

5. Which finding in a 2-year-old most strongly suggests intussusception?

Projectile non-bilious vomiting with an "olive" mass
Barky cough and inspiratory stridor
Chronic constipation with hard stools
Colicky pain with "currant jelly" stools and a sausage-shaped mass

Rationale

Answer: 4. Currant jelly stools, colicky pain, and a sausage-shaped mass are classic for intussusception. Option 1 is pyloric stenosis, 2 is croup, and 3 is simple constipation.

6. SATA. Which findings in a child with Kawasaki disease support the diagnosis? Select all that apply.

Fever lasting 5 or more days
Bilateral conjunctivitis
Strawberry tongue and red, cracked lips
Barky, seal-like cough
Swelling/redness of the hands and feet

Rationale

Answers: 1, 2, 3, 5. Prolonged fever, conjunctivitis, mucosal changes (strawberry tongue/cracked lips), and extremity changes are Kawasaki features. A barky cough (4) points to croup, not Kawasaki.

7. SATA. Which are appropriate nursing actions during a sickle cell vaso-occlusive crisis? Select all that apply.

Administer IV fluids for hydration
Provide oxygen as needed
Apply cold packs to painful joints
Administer prescribed analgesics, including opioids, for pain
Monitor for acute chest syndrome

Rationale

Answers: 1, 2, 4, 5. Hydration, oxygen, adequate analgesia, and monitoring for acute chest syndrome are correct. Cold (3) causes vasoconstriction and worsens sickling—use warmth instead.

8. Priority. The nurse is caring for four children. Which should be assessed first?

A child with epiglottitis who is drooling and beginning to look anxious with increasing stridor
A child with gastroenteritis tolerating oral fluids
A child with a healing pyloromyotomy incision
A child with asthma whose wheezing improved after albuterol

Rationale

Answer: 1. Increasing stridor and anxiety in epiglottitis signal impending airway obstruction—the priority. The others are stable/improving.

9. Delegation. Which task is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)?

Administering the child's scheduled insulin
Teaching parents how to use an inhaler with a spacer
Obtaining vital signs and weighing a stable child
Assessing a child's respiratory status during a crisis

Rationale

Answer: 3. UAP may take vitals and weigh a stable child. Administering insulin (1, high-alert), teaching (2), and assessment (4) require the RN.

10. NGN Case Study. A 10-month-old is admitted with 2 days of cough, coryza, and wheezing; RSV is positive. Temp 100.8°F, RR 64, mild retractions, SpO₂ 91%, feeding poorly, 2 wet diapers in 12 hours.

10a. Which findings require the nurse's immediate attention? Select all that apply.

RR of 64 with retractions
SpO₂ of 91%
Positive RSV test
Two wet diapers in 12 hours
Poor feeding

Rationale

Answers: 1, 2, 4, 5. Tachypnea with retractions, hypoxia, decreased urine output, and poor feeding signal respiratory distress and dehydration risk in bronchiolitis. A positive RSV test (3) explains the cause but isn't itself an urgent, actionable vital sign.

10b. Which interventions are appropriate? Select all that apply.

Institute contact/droplet precautions
Suction the nares before feeding and provide oxygen for hypoxia
Give aspirin for fever
Monitor hydration, I&O, and respiratory status closely
Encourage small, frequent feeds as tolerated

Rationale

Answers: 1, 2, 4, 5. Isolation precautions, nasal suctioning/oxygen, close monitoring, and small frequent feeds support the infant. Aspirin (3) is contraindicated (Reye syndrome)—use weight-based acetaminophen/ibuprofen.

Key Takeaways

Airway first: stridor = upper airway (croup/epiglottitis), wheeze = lower (bronchiolitis/asthma). In epiglottitis, keep the child calm and never inspect the throat; a silent chest in asthma is an emergency.
GI: gastroenteritis → dehydration; pyloric stenosis = projectile non-bilious vomiting + hypochloremic hypokalemic alkalosis; intussusception = currant jelly stool + colicky pain (emergency).
Neuro: most febrile seizures are benign but rule out meningitis; meningitis red flags include nuchal rigidity, bulging fontanel, and petechial rash—give antibiotics promptly.
Endocrine: DKA order = fluids, insulin drip, potassium; lower glucose slowly to prevent cerebral edema; insulin is high-alert.
Hematologic: sickle cell crisis → hydration, oxygen, pain control; avoid cold and dehydration; watch for acute chest syndrome.
Infectious/congenital: Kawasaki → IVIG + aspirin to protect coronary arteries; congenital defects → L→R (acyanotic, HF risk) vs. R→L (cyanotic, tet spells → knee-to-chest).
Use weight in kg, recognize early compensation before collapse, and provide atraumatic, family-centered care.

References

Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2022). Wong's essentials of pediatric nursing (11th ed.). Elsevier.
Kyle, T., & Carman, S. (2021). Essentials of pediatric nursing (4th ed.). Wolters Kluwer/Lippincott.
Ball, J. W., Bindler, R. C., Cowen, K. J., & Shaw, M. R. (2019). Principles of pediatric nursing: Caring for children (7th ed.). Pearson.
Silvestri, L. A., & Silvestri, A. E. (2023). Saunders comprehensive review for the NCLEX-RN examination (9th ed.). Elsevier.
Assessment Technologies Institute. (2023). ATI RN nursing care of children review module (12th ed.). ATI Nursing Education.
American Academy of Pediatrics. (2023). Red book: Report of the Committee on Infectious Diseases (33rd ed.). AAP.
American Diabetes Association. (2024). Standards of care in diabetes—2024: Children and adolescents. Diabetes Care, 47(Suppl. 1). https://diabetesjournals.org
Centers for Disease Control and Prevention. (2024). RSV, meningococcal, and childhood immunization guidance. U.S. Department of Health and Human Services. https://www.cdc.gov
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier.

Common Pediatric Disorders

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Welcome & Getting Started

Launch RN Simulator

Wellness Center

Nursing Foundations

Fundamentals & Safety

Pharmacology

Dosage Calculations

Leadership, Management & Delegation

Medical-Surgical Body Systems

Neurological System

Sensory System

Endocrine System

Respiratory System

Cardiovascular System

Hematologic/Immune/Lymphatic System

Gastrointestinal (GI) System

Renal & Genitourinary

Reproductive System

Musculoskeletal System

Integumentary System

Specialty Areas

Maternity

Infectious Diseases

Pediatrics

Mental Health

NCLEX Success Center

Clinical Judgment Practice

Prioritization Practice

Delegation Practice

Lab Values

Final Review