NR 328,100 NCLEX-STYLE QUESTIONS ON
PEDIATRIC NURSING CARE GASTROINTESTINAL
AND ELIMINATION ALTERATIONS LATEST
STUDY GUIDE 2026
Question 1
A 2-year-old child is admitted with severe diarrhea and vomiting for
the past 24 hours. The nurse notes dry mucous membranes,
decreased urine output, and lethargy. Which intervention should the
nurse prioritize?
A. Administering an antiemetic medication B. Initiating IV fluid
therapy C. Providing frequent small sips of clear liquids D. Collecting
a stool sample for culture
Answer: B. Initiating IV fluid therapy
Rationale: The child is exhibiting signs of moderate to severe
dehydration (dry mucous membranes, decreased urine output,
lethargy) due to fluid loss from diarrhea and vomiting. IV fluid
therapy is the priority intervention to rapidly correct fluid and
electrolyte imbalances. While antiemetics, oral rehydration, and
diagnostic testing are important, correcting dehydration is the most
immediate need to prevent hemodynamic compromise.
Question 2
A nurse is caring for a 5-year-old with confirmed rotavirus
gastroenteritis. Which infection control measures should the nurse
implement? (Select all that apply)
A. Airborne precautions B. Contact precautions C. Droplet precautions
D. Standard precautions E. Hand hygiene with alcohol-based hand
sanitizer F. Hand hygiene with soap and water
Answer: B, D, F
Rationale: Rotavirus is transmitted through the fecal-oral route and
requires contact precautions (B) in addition to standard precautions
(D). Hand hygiene with soap and water (F) is more effective than
alcohol-based sanitizers for removing rotavirus from hands, as the
virus is not effectively killed by alcohol-based products. Airborne and
droplet precautions are not indicated for rotavirus infections.
Question 3
,The nurse is providing discharge instructions to parents of a 3-
year-old recovering from acute gastroenteritis. Which
statement by the parents indicates a need for further teaching?
A. "We'll continue to give small amounts of fluids frequently." B.
"We'll avoid dairy products for the next 2-3 weeks." C. "We'll monitor
for signs of dehydration like decreased urination." D. "We'll gradually
reintroduce a regular diet as tolerated."
Answer: B. "We'll avoid dairy products for the next 2-3
weeks."
Rationale: Avoiding dairy products for 2-3 weeks is unnecessarily
restrictive. While temporary lactose intolerance can develop
following gastroenteritis, most children can resume their normal
diet, including dairy, within 24-48 hours as tolerated. Gradual
reintroduction of regular diet, continued oral rehydration, and
monitoring for dehydration are appropriate discharge instructions.
Question 4
A 1-year-old child with acute gastroenteritis has been receiving IV
fluids for severe dehydration. The nurse recognizes that the child is
ready for oral rehydration when:
A. The child is afebrile for 24 hours B. Vomiting has completely
stopped C. Diarrhea has completely resolved D. Oral mucosa is moist
and urine output is adequate
Answer: D. Oral mucosa is moist and urine output is
adequate
Rationale: Adequate hydration status, as evidenced by moist
mucous membranes and appropriate urine output, indicates that the
child is ready to transition from IV to oral rehydration. Fever,
vomiting, and diarrhea may still be present but improving as the
child recovers. The goal is to transition to oral intake as soon as
dehydration is corrected, even if other symptoms persist.
Question 5
The nurse is caring for a 4-year-old with a diagnosis of
intussusception. Which assessment finding would the nurse expect
in this child?
A. Projectile vomiting after feeding B. Clay-colored stools C. Current-
jelly stools D. Tarry stools
Answer: C. Current-jelly stools
,Rationale: "Current-jelly" stools (red mucus mixed with stool) are
characteristic of intussusception due to the telescoping of one portion
of the intestine into another, causing blood and mucus in the stool.
Projectile vomiting is typically associated with pyloric stenosis, clay-
colored stools with biliary obstruction, and tarry stools (melena) with
upper GI bleeding.
Question 6
A 13-year-old is admitted with suspected inflammatory bowel
disease. Which laboratory finding would the nurse expect to be
elevated in this condition? (Select all that apply)
A. Erythrocyte sedimentation rate (ESR) B. C-reactive protein (CRP) C.
White blood cell count D. Amylase E. Liver enzymes
Answer: A, B, C
Rationale: Inflammatory bowel disease (IBD) causes systemic
inflammation, resulting in elevated inflammatory markers including
ESR (A), CRP (B), and white blood cell count (C). Amylase is typically
elevated in pancreatic disorders, not IBD. Liver enzymes may be
elevated if there is extraintestinal involvement of the liver, but this is
not a primary finding in IBD.
Question 7
While assessing a 5-year-old with suspected appendicitis, which
finding would most specifically suggest this diagnosis?
A. Diffuse abdominal pain B. Pain in the right lower quadrant with
rebound tenderness C. Pain relieved by defecation D. Periumbilical
pain radiating to the back
Answer: B. Pain in the right lower quadrant with
rebound tenderness
Rationale: Localized pain in the right lower quadrant (McBurney's
point) with rebound tenderness is a classic finding in appendicitis.
As inflammation progresses, the initially diffuse or periumbilical pain
typically localizes to the right lower quadrant. Diffuse abdominal
pain is nonspecific, pain relieved by defecation suggests irritable
bowel syndrome, and periumbilical pain radiating to the back is
more consistent with pancreatitis.
Question 8
, A 2-month-old infant diagnosed with pyloric stenosis is scheduled for
a pyloromyotomy. The nurse should expect which clinical
manifestation in this infant?
A. Diarrhea with mucus B. Projectile vomiting C. Blood-streaked stool
D. Progressive abdominal distention
Answer: B. Projectile vomiting
Rationale: Projectile (forceful) non-bilious vomiting is the classic
presentation of pyloric stenosis due to the hypertrophy and
narrowing of the pyloric sphincter, which obstructs gastric emptying.
Diarrhea with mucus may indicate an infectious process, blood-
streaked stool suggests intestinal inflammation or intussusception,
and progressive abdominal distention is more consistent with
intestinal obstruction.
Question 9
A nurse is caring for an infant with gastroesophageal reflux
disease (GERD). Which nursing interventions would be
appropriate? (Select all that apply)
A. Positioning the infant flat after feeding B. Elevating the head of the
crib 30 degrees C. Thickening formula with rice cereal as prescribed
D. Administering feedings continuously via feeding pump E. Burping
the infant frequently during and after feeding
Answer: B, C, E
Rationale: For an infant with GERD, appropriate interventions
include elevating the head of the crib (B) to reduce reflux by
gravity, thickening feeds with rice cereal as prescribed (C) to
increase the weight of stomach contents, and frequent burping (E)
to release swallowed air. The infant should not be positioned flat
after feeding (A) as this promotes reflux.
Continuous feedings via pump (D) are not a first-line treatment for
uncomplicated GERD.
Question 10
A 7-year-old with Crohn's disease has been prescribed corticosteroids.
Which nursing assessment is most important when monitoring this
child?
A. Daily weight measurements B. Hourly intake and output C. Twice
daily blood glucose levels D. Weekly complete blood count
Answer: C. Twice daily blood glucose levels
PEDIATRIC NURSING CARE GASTROINTESTINAL
AND ELIMINATION ALTERATIONS LATEST
STUDY GUIDE 2026
Question 1
A 2-year-old child is admitted with severe diarrhea and vomiting for
the past 24 hours. The nurse notes dry mucous membranes,
decreased urine output, and lethargy. Which intervention should the
nurse prioritize?
A. Administering an antiemetic medication B. Initiating IV fluid
therapy C. Providing frequent small sips of clear liquids D. Collecting
a stool sample for culture
Answer: B. Initiating IV fluid therapy
Rationale: The child is exhibiting signs of moderate to severe
dehydration (dry mucous membranes, decreased urine output,
lethargy) due to fluid loss from diarrhea and vomiting. IV fluid
therapy is the priority intervention to rapidly correct fluid and
electrolyte imbalances. While antiemetics, oral rehydration, and
diagnostic testing are important, correcting dehydration is the most
immediate need to prevent hemodynamic compromise.
Question 2
A nurse is caring for a 5-year-old with confirmed rotavirus
gastroenteritis. Which infection control measures should the nurse
implement? (Select all that apply)
A. Airborne precautions B. Contact precautions C. Droplet precautions
D. Standard precautions E. Hand hygiene with alcohol-based hand
sanitizer F. Hand hygiene with soap and water
Answer: B, D, F
Rationale: Rotavirus is transmitted through the fecal-oral route and
requires contact precautions (B) in addition to standard precautions
(D). Hand hygiene with soap and water (F) is more effective than
alcohol-based sanitizers for removing rotavirus from hands, as the
virus is not effectively killed by alcohol-based products. Airborne and
droplet precautions are not indicated for rotavirus infections.
Question 3
,The nurse is providing discharge instructions to parents of a 3-
year-old recovering from acute gastroenteritis. Which
statement by the parents indicates a need for further teaching?
A. "We'll continue to give small amounts of fluids frequently." B.
"We'll avoid dairy products for the next 2-3 weeks." C. "We'll monitor
for signs of dehydration like decreased urination." D. "We'll gradually
reintroduce a regular diet as tolerated."
Answer: B. "We'll avoid dairy products for the next 2-3
weeks."
Rationale: Avoiding dairy products for 2-3 weeks is unnecessarily
restrictive. While temporary lactose intolerance can develop
following gastroenteritis, most children can resume their normal
diet, including dairy, within 24-48 hours as tolerated. Gradual
reintroduction of regular diet, continued oral rehydration, and
monitoring for dehydration are appropriate discharge instructions.
Question 4
A 1-year-old child with acute gastroenteritis has been receiving IV
fluids for severe dehydration. The nurse recognizes that the child is
ready for oral rehydration when:
A. The child is afebrile for 24 hours B. Vomiting has completely
stopped C. Diarrhea has completely resolved D. Oral mucosa is moist
and urine output is adequate
Answer: D. Oral mucosa is moist and urine output is
adequate
Rationale: Adequate hydration status, as evidenced by moist
mucous membranes and appropriate urine output, indicates that the
child is ready to transition from IV to oral rehydration. Fever,
vomiting, and diarrhea may still be present but improving as the
child recovers. The goal is to transition to oral intake as soon as
dehydration is corrected, even if other symptoms persist.
Question 5
The nurse is caring for a 4-year-old with a diagnosis of
intussusception. Which assessment finding would the nurse expect
in this child?
A. Projectile vomiting after feeding B. Clay-colored stools C. Current-
jelly stools D. Tarry stools
Answer: C. Current-jelly stools
,Rationale: "Current-jelly" stools (red mucus mixed with stool) are
characteristic of intussusception due to the telescoping of one portion
of the intestine into another, causing blood and mucus in the stool.
Projectile vomiting is typically associated with pyloric stenosis, clay-
colored stools with biliary obstruction, and tarry stools (melena) with
upper GI bleeding.
Question 6
A 13-year-old is admitted with suspected inflammatory bowel
disease. Which laboratory finding would the nurse expect to be
elevated in this condition? (Select all that apply)
A. Erythrocyte sedimentation rate (ESR) B. C-reactive protein (CRP) C.
White blood cell count D. Amylase E. Liver enzymes
Answer: A, B, C
Rationale: Inflammatory bowel disease (IBD) causes systemic
inflammation, resulting in elevated inflammatory markers including
ESR (A), CRP (B), and white blood cell count (C). Amylase is typically
elevated in pancreatic disorders, not IBD. Liver enzymes may be
elevated if there is extraintestinal involvement of the liver, but this is
not a primary finding in IBD.
Question 7
While assessing a 5-year-old with suspected appendicitis, which
finding would most specifically suggest this diagnosis?
A. Diffuse abdominal pain B. Pain in the right lower quadrant with
rebound tenderness C. Pain relieved by defecation D. Periumbilical
pain radiating to the back
Answer: B. Pain in the right lower quadrant with
rebound tenderness
Rationale: Localized pain in the right lower quadrant (McBurney's
point) with rebound tenderness is a classic finding in appendicitis.
As inflammation progresses, the initially diffuse or periumbilical pain
typically localizes to the right lower quadrant. Diffuse abdominal
pain is nonspecific, pain relieved by defecation suggests irritable
bowel syndrome, and periumbilical pain radiating to the back is
more consistent with pancreatitis.
Question 8
, A 2-month-old infant diagnosed with pyloric stenosis is scheduled for
a pyloromyotomy. The nurse should expect which clinical
manifestation in this infant?
A. Diarrhea with mucus B. Projectile vomiting C. Blood-streaked stool
D. Progressive abdominal distention
Answer: B. Projectile vomiting
Rationale: Projectile (forceful) non-bilious vomiting is the classic
presentation of pyloric stenosis due to the hypertrophy and
narrowing of the pyloric sphincter, which obstructs gastric emptying.
Diarrhea with mucus may indicate an infectious process, blood-
streaked stool suggests intestinal inflammation or intussusception,
and progressive abdominal distention is more consistent with
intestinal obstruction.
Question 9
A nurse is caring for an infant with gastroesophageal reflux
disease (GERD). Which nursing interventions would be
appropriate? (Select all that apply)
A. Positioning the infant flat after feeding B. Elevating the head of the
crib 30 degrees C. Thickening formula with rice cereal as prescribed
D. Administering feedings continuously via feeding pump E. Burping
the infant frequently during and after feeding
Answer: B, C, E
Rationale: For an infant with GERD, appropriate interventions
include elevating the head of the crib (B) to reduce reflux by
gravity, thickening feeds with rice cereal as prescribed (C) to
increase the weight of stomach contents, and frequent burping (E)
to release swallowed air. The infant should not be positioned flat
after feeding (A) as this promotes reflux.
Continuous feedings via pump (D) are not a first-line treatment for
uncomplicated GERD.
Question 10
A 7-year-old with Crohn's disease has been prescribed corticosteroids.
Which nursing assessment is most important when monitoring this
child?
A. Daily weight measurements B. Hourly intake and output C. Twice
daily blood glucose levels D. Weekly complete blood count
Answer: C. Twice daily blood glucose levels
