NCLEX Question of the Day – Saturday, May 02, 2026

Today’s question targets safe medication administration in pediatric nursing, especially how to recognize early signs of fluid overload during IV therapy. This matters because children can deteriorate quickly. A nurse who notices subtle changes early can prevent respiratory distress, cardiac strain, and a rapid transfer to higher-level care.

Clinical Scenario

A 4-year-old child is admitted to a pediatric unit with dehydration after 2 days of vomiting and poor oral intake. The child weighs 16 kg and has been receiving IV maintenance fluids through a peripheral line for the last 8 hours. The provider prescribed strict intake and output monitoring.

During the nurse’s reassessment, the child is less playful than earlier in the shift. The parent says, “He seems puffier around the eyes now.” The nurse notes a heart rate of 132/min, respiratory rate of 30/min, blood pressure within expected range for age, and oxygen saturation of 96% on room air. Urine output has been adequate. On auscultation, the nurse hears new fine crackles at the lung bases.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Slow the IV rate and continue to monitor the child for another hour
2. B. Stop the IV infusion and notify the provider of suspected fluid overload
3. C. Place the child flat in bed to reduce energy use and promote rest
4. D. Encourage the parent to offer oral fluids to maintain hydration

Correct Answer

B. Stop the IV infusion and notify the provider of suspected fluid overload

Detailed Rationale

This child is showing several signs that point to fluid overload: periorbital puffiness, decreased activity, tachycardia, and new fine crackles. In a child receiving IV fluids, crackles are especially important because they suggest fluid is moving into the lungs. That can progress to breathing problems fast.

The first priority is to stop the source of the problem. In this case, that source is the IV infusion. If the nurse leaves the fluids running, even at a slower rate, more fluid may continue to accumulate. Stopping the infusion helps prevent further overload while the nurse gets additional orders.

After stopping the IV, the nurse should notify the provider promptly and be ready to report focused assessment findings. That report should include current vital signs, lung sounds, urine output, weight if available, intake totals, appearance of edema, and the type and rate of IV fluids. These details matter because they help confirm the severity of overload and guide next steps such as reducing fluids, changing the order, or giving a diuretic if prescribed.

The nurse should also continue close monitoring. That includes reassessing respiratory effort, oxygen saturation, work of breathing, and lung sounds. In pediatrics, subtle changes matter. A child may first look mildly puffy or less active before showing obvious respiratory distress. Watching trends is just as important as one abnormal finding.

The nurse should position the child to support breathing, usually with the head of the bed elevated. This is not the first action in the answer choices, but it is an important follow-up nursing measure. The nurse should also verify whether there were any recent changes in the infusion rate, whether the pump was programmed correctly, and whether intake and output totals match the charted plan. Medication safety and infusion accuracy are part of the assessment because children are more sensitive to excess volume.

The key nursing principle here is this: when a treatment appears to be causing harm, stop or hold it if it is within nursing scope and then escalate. That is why option B is the safest first action.

Why the Other Options Are Wrong

A. Slow the IV rate and continue to monitor the child for another hour

This is not enough. The child already has new crackles, which means there is evidence of fluid affecting the lungs. Waiting another hour delays intervention and increases risk. The nurse should not “watch and wait” when signs of overload are already present.

C. Place the child flat in bed to reduce energy use and promote rest

This can make breathing worse. A flat position can increase discomfort and may worsen respiratory effort when fluid is present in the lungs. If anything, the child should be positioned upright or with the head of the bed elevated to improve lung expansion.

D. Encourage the parent to offer oral fluids to maintain hydration

This goes in the wrong direction. The concern is not ongoing dehydration now. The concern is excess fluid volume. Adding oral fluids before the nurse clarifies the child’s status could worsen the overload.

Key Takeaways

• In children, early fluid overload may show up as periorbital edema, tachycardia, decreased activity, and new crackles.
• New lung crackles during IV therapy are a red flag. They suggest fluid is affecting the lungs.
• The first action is to stop the IV infusion if it is likely contributing to harm, then notify the provider.
• Do not rely on urine output alone. A child can still have adequate output and be developing overload.
• Positioning matters. Elevate the head of the bed to support breathing.

• What you’d do on shift: stop the IV, reassess breath sounds and work of breathing, check oxygen saturation, review total intake and output, confirm the programmed IV rate, elevate the head of the bed, and call the provider with focused findings.

Quick Practice Extension

1. A school-age child receiving IV antibiotics suddenly develops facial swelling, wheezing, and hives. What is the nurse’s priority action?

2. A toddler with gastroenteritis has dry mucous membranes, delayed capillary refill, and no tears when crying. Which assessment finding would best show that fluid replacement is working?

Category: Pediatrics

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