NU 170 NURSING FUNDAMENTALS EXAM 3 (PDF) | 2026
QUESTIONS AND ANSWERS + RATIONALES | STUDY GUIDE |
100% CORRECT
1. A 2-year-old child presents with vomiting and diarrhea for 3 days. Which assessment
finding indicates severe dehydration requiring immediate intervention?
A) Dry mucous membranes
B) Decreased skin turgor
C) Lethargy and decreased urine output
D) Sunken fontanelle
Correct Answer: Lethargy and decreased urine output
Rationale: Lethargy and decreased urine output are signs of severe dehydration requiring
immediate intervention . Dry mucous membranes, decreased skin turgor, and sunken fontanelle
indicate moderate dehydration, not severe . The child should be assessed for signs of shock, and
IV fluids may be needed.
2. A nurse is assessing a child with acute gastroenteritis. Which finding is most concerning
for the development of dehydration?
A) Dry mucous membranes
B) Decreased skin turgor
C) Sunken fontanelle
D) All of the above
Correct Answer: All of the above
Rationale: Dry mucous membranes, decreased skin turgor, and a sunken fontanelle are all signs
of dehydration in children with gastroenteritis . The nurse should assess for these findings and
implement rehydration therapy. Severe dehydration is a medical emergency and requires prompt
intervention.
3. The nurse is caring for a child with acute gastroenteritis. Which intervention is most
important for preventing dehydration?
A) Administer antiemetics
B) Encourage oral rehydration therapy
C) Restrict fluids
D) Administer antibiotics
Correct Answer: Encourage oral rehydration therapy
Rationale: Oral rehydration therapy with an appropriate solution (e.g., Pedialyte) is the most
important intervention for preventing dehydration in children with gastroenteritis . Antiemetics
and antibiotics may be used in specific situations but are not the primary intervention for
preventing fluid loss.
, 4. A parent reports that their 6-month-old infant has had diarrhea for 2 days. Which finding
would indicate the infant is developing moderate dehydration?
A) Normal urine output
B) Sunken fontanelle and dry mucous membranes
C) Lethargy and oliguria
D) Normal skin turgor
Correct Answer: Sunken fontanelle and dry mucous membranes
Rationale: Sunken fontanelle, dry mucous membranes, and decreased skin turgor indicate
moderate dehydration . Severe dehydration presents with lethargy, oliguria, and signs of shock.
Normal urine output and skin turgor indicate mild or no dehydration.
5. Which of the following is a correct component of a rehydration plan for a child with mild
to moderate dehydration?
A) Administer clear fluids only (water, juice)
B) Provide oral rehydration solution (ORS) in small, frequent amounts
C) Restrict all fluids for 12 hours
D) Administer antiemetics before any fluids
Correct Answer: Provide oral rehydration solution (ORS) in small, frequent amounts
Rationale: Oral rehydration solution (ORS) is the preferred fluid for rehydration in children with
mild to moderate dehydration . Clear fluids like water and juice do not contain the appropriate
electrolyte balance. Fluids should not be restricted, and antiemetics are not typically needed.
6. The nurse is caring for a child who has been vomiting and has developed metabolic
alkalosis. Which finding supports this acid-base imbalance?
A) Hypoventilation
B) Hyperventilation
C) Increased bicarbonate levels
D) Decreased pH
Correct Answer: Increased bicarbonate levels
Rationale: Vomiting leads to loss of hydrochloric acid and subsequent metabolic alkalosis . Lab
findings include increased bicarbonate and increased pH. Hypoventilation is a compensatory
response but is not a direct finding of metabolic alkalosis.
7. A child with gastroenteritis has been receiving IV fluids. The nurse notes that the child is
now alert, has moist mucous membranes, and has started producing urine. Which stage of
dehydration treatment has been achieved?
A) Deficit replacement
B) Maintenance
C) Ongoing losses replacement
D) Resolution
Correct Answer: Resolution
QUESTIONS AND ANSWERS + RATIONALES | STUDY GUIDE |
100% CORRECT
1. A 2-year-old child presents with vomiting and diarrhea for 3 days. Which assessment
finding indicates severe dehydration requiring immediate intervention?
A) Dry mucous membranes
B) Decreased skin turgor
C) Lethargy and decreased urine output
D) Sunken fontanelle
Correct Answer: Lethargy and decreased urine output
Rationale: Lethargy and decreased urine output are signs of severe dehydration requiring
immediate intervention . Dry mucous membranes, decreased skin turgor, and sunken fontanelle
indicate moderate dehydration, not severe . The child should be assessed for signs of shock, and
IV fluids may be needed.
2. A nurse is assessing a child with acute gastroenteritis. Which finding is most concerning
for the development of dehydration?
A) Dry mucous membranes
B) Decreased skin turgor
C) Sunken fontanelle
D) All of the above
Correct Answer: All of the above
Rationale: Dry mucous membranes, decreased skin turgor, and a sunken fontanelle are all signs
of dehydration in children with gastroenteritis . The nurse should assess for these findings and
implement rehydration therapy. Severe dehydration is a medical emergency and requires prompt
intervention.
3. The nurse is caring for a child with acute gastroenteritis. Which intervention is most
important for preventing dehydration?
A) Administer antiemetics
B) Encourage oral rehydration therapy
C) Restrict fluids
D) Administer antibiotics
Correct Answer: Encourage oral rehydration therapy
Rationale: Oral rehydration therapy with an appropriate solution (e.g., Pedialyte) is the most
important intervention for preventing dehydration in children with gastroenteritis . Antiemetics
and antibiotics may be used in specific situations but are not the primary intervention for
preventing fluid loss.
, 4. A parent reports that their 6-month-old infant has had diarrhea for 2 days. Which finding
would indicate the infant is developing moderate dehydration?
A) Normal urine output
B) Sunken fontanelle and dry mucous membranes
C) Lethargy and oliguria
D) Normal skin turgor
Correct Answer: Sunken fontanelle and dry mucous membranes
Rationale: Sunken fontanelle, dry mucous membranes, and decreased skin turgor indicate
moderate dehydration . Severe dehydration presents with lethargy, oliguria, and signs of shock.
Normal urine output and skin turgor indicate mild or no dehydration.
5. Which of the following is a correct component of a rehydration plan for a child with mild
to moderate dehydration?
A) Administer clear fluids only (water, juice)
B) Provide oral rehydration solution (ORS) in small, frequent amounts
C) Restrict all fluids for 12 hours
D) Administer antiemetics before any fluids
Correct Answer: Provide oral rehydration solution (ORS) in small, frequent amounts
Rationale: Oral rehydration solution (ORS) is the preferred fluid for rehydration in children with
mild to moderate dehydration . Clear fluids like water and juice do not contain the appropriate
electrolyte balance. Fluids should not be restricted, and antiemetics are not typically needed.
6. The nurse is caring for a child who has been vomiting and has developed metabolic
alkalosis. Which finding supports this acid-base imbalance?
A) Hypoventilation
B) Hyperventilation
C) Increased bicarbonate levels
D) Decreased pH
Correct Answer: Increased bicarbonate levels
Rationale: Vomiting leads to loss of hydrochloric acid and subsequent metabolic alkalosis . Lab
findings include increased bicarbonate and increased pH. Hypoventilation is a compensatory
response but is not a direct finding of metabolic alkalosis.
7. A child with gastroenteritis has been receiving IV fluids. The nurse notes that the child is
now alert, has moist mucous membranes, and has started producing urine. Which stage of
dehydration treatment has been achieved?
A) Deficit replacement
B) Maintenance
C) Ongoing losses replacement
D) Resolution
Correct Answer: Resolution
