NUR 203 /NUR203 Exam 3 Pediatric Nursing
2026/2027/2028 Testing Cycle | Newly Released
50 Questions With Answers & Expert Rationales
Guaranteed Pass | Graded A+ | Fortis College
Endocrine, Gastrointestinal, & Renal Alterations
Q1: A school-age child with central diabetes insipidus is admitted to the pediatric unit. Which
clinical findings should the nurse expect to document?
A. Weight gain, peripheral edema, and concentrated urine
B. Fluid retention, hyponatremia, and high urine specific gravity
C. Polyuria, polydipsia, and low urine specific gravity
D. Oliguria, hypotension, and metabolic acidosis
Correct Answer: C
Rationale: Correct because central diabetes insipidus results from antidiuretic hormone
deficiency, which impairs the kidneys' ability to reabsorb water and produces massive polyuria,
intense compensatory polydipsia, and dilute urine with a specific gravity below 1.005. These
findings contrast sharply with syndrome of inappropriate antidiuretic hormone, which presents
with fluid retention, concentrated urine, and hyponatremia. The nurse must monitor daily
weights, intake and output, and serum osmolality to guide desmopressin therapy and prevent
severe dehydration.
Q2: A 7-year-old is admitted with periorbital edema, cola-colored urine, and a blood pressure of
150/95 mmHg. The parents report he had strep throat two weeks ago. The nurse recognizes this
presentation is most consistent with which condition?
A. Acute glomerulonephritis
B. Nephrotic syndrome
C. Urinary tract infection
D. Pyelonephritis
Correct Answer: A
Rationale: Correct because acute glomerulonephritis classically presents 1 to 3 weeks after a
,group A beta-hemolytic streptococcal infection with the triad of gross hematuria producing cola-
colored urine, periorbital edema, and severe hypertension due to immune complex deposition
and decreased glomerular filtration. Nephrotic syndrome manifests with massive proteinuria and
generalized edema rather than gross hematuria and hypertension. Early recognition allows the
nurse to implement bed rest, fluid and sodium restriction, and blood pressure monitoring during
the acute phase.
Q3: A newborn develops progressive jaundice at 3 weeks of age. The parents report dark tea-
colored urine and pale, clay-colored stools. Which condition should the nurse suspect?
A. Physiologic jaundice
B. Hemolytic disease of the newborn
C. Hypertrophic pyloric stenosis
D. Biliary atresia
Correct Answer: D
Rationale: Correct because biliary atresia is characterized by progressive obstruction of the
extrahepatic bile ducts that produces progressive jaundice beyond the neonatal period, dark tea-
colored urine from conjugated bilirubin excretion, and clay-colored acholic stools due to absent
bile pigment in the gastrointestinal tract. Physiologic jaundice resolves within 1 to 2 weeks, and
hypertrophic pyloric stenosis presents with projectile vomiting rather than cholestatic findings.
The nurse should anticipate diagnostic workup including elevated direct bilirubin and a HIDA
scan, followed by urgent hepatoportoenterostomy before 60 days of age.
Q4: A nurse is teaching parents of an infant with gastroesophageal reflux about feeding
interventions. Which instructions should the nurse include? Select all that apply.
A. Place the infant in a car seat immediately after feeding
B. Thicken formula with infant rice cereal as prescribed
C. Hold the infant upright for 30 minutes after every feeding
D. Offer large-volume feedings every 4 hours
E. Burp the infant frequently throughout the feeding
Correct Answer: B, C, E
Rationale: Correct because thickening formula with infant rice cereal reduces the volume of
gastric contents available for reflux, holding the infant upright for 30 minutes after feeding uses
gravity to minimize retrograde flow, and frequent burping decreases gastric distension that
exacerbates sphincter relaxation. Placing the infant in a car seat immediately after feeding
increases intra-abdominal pressure from slouching and worsens reflux, while large-volume
feedings overwhelm the gastric capacity and increase regurgitation. These evidence-based
, feeding interventions reduce aspiration risk and support adequate nutrition in infants with
gastroesophageal reflux.
Q5: A 4-week-old infant has projectile, non-bilious vomiting immediately after every feeding
and remains eager to eat. During the physical examination, which finding supports the suspected
diagnosis?
A. Palpable sausage-shaped mass in the left lower quadrant
B. Olive-shaped mass in the right upper quadrant
C. Board-like rigid abdomen with rebound tenderness
D. High-pitched tinkling bowel sounds diffusely
Correct Answer: B
Rationale: Correct because hypertrophic pyloric stenosis produces a palpable olive-shaped mass
in the right upper quadrant as the hypertrophied pyloric muscle becomes distended and palpable
during or after feeding when the stomach is full. A sausage-shaped mass in the left lower
quadrant suggests intussusception, a rigid board-like abdomen indicates peritonitis, and high-
pitched tinkling bowel sounds suggest bowel obstruction from other causes. Recognition of this
classic finding prompts surgical consultation for pyloromyotomy after correcting hypochloremic
metabolic alkalosis.
Q6: A 6-year-old with short stature is scheduled for growth hormone stimulation testing. Which
instruction is most important for the nurse to provide to the parents?
A. The child must remain NPO prior to the test
B. The child should eat a high-carbohydrate breakfast before arrival
C. Administer the prescribed growth hormone injection the night before
D. Encourage vigorous exercise on the morning of the test
Correct Answer: A
Rationale: Correct because growth hormone stimulation testing requires the child to be NPO
and fasting prior to administration of a stimulating agent such as levodopa or arginine, since food
intake alters baseline hormone levels and invalidates results. Blood samples are drawn at precise
30-minute intervals for 2 hours because growth hormone is secreted in pulsatile bursts rather
than steady states. The nurse must ensure fasting status, monitor for hypoglycemia if insulin-
induced hypoglycemia is used, and document the protocol to confirm growth hormone
deficiency.
2026/2027/2028 Testing Cycle | Newly Released
50 Questions With Answers & Expert Rationales
Guaranteed Pass | Graded A+ | Fortis College
Endocrine, Gastrointestinal, & Renal Alterations
Q1: A school-age child with central diabetes insipidus is admitted to the pediatric unit. Which
clinical findings should the nurse expect to document?
A. Weight gain, peripheral edema, and concentrated urine
B. Fluid retention, hyponatremia, and high urine specific gravity
C. Polyuria, polydipsia, and low urine specific gravity
D. Oliguria, hypotension, and metabolic acidosis
Correct Answer: C
Rationale: Correct because central diabetes insipidus results from antidiuretic hormone
deficiency, which impairs the kidneys' ability to reabsorb water and produces massive polyuria,
intense compensatory polydipsia, and dilute urine with a specific gravity below 1.005. These
findings contrast sharply with syndrome of inappropriate antidiuretic hormone, which presents
with fluid retention, concentrated urine, and hyponatremia. The nurse must monitor daily
weights, intake and output, and serum osmolality to guide desmopressin therapy and prevent
severe dehydration.
Q2: A 7-year-old is admitted with periorbital edema, cola-colored urine, and a blood pressure of
150/95 mmHg. The parents report he had strep throat two weeks ago. The nurse recognizes this
presentation is most consistent with which condition?
A. Acute glomerulonephritis
B. Nephrotic syndrome
C. Urinary tract infection
D. Pyelonephritis
Correct Answer: A
Rationale: Correct because acute glomerulonephritis classically presents 1 to 3 weeks after a
,group A beta-hemolytic streptococcal infection with the triad of gross hematuria producing cola-
colored urine, periorbital edema, and severe hypertension due to immune complex deposition
and decreased glomerular filtration. Nephrotic syndrome manifests with massive proteinuria and
generalized edema rather than gross hematuria and hypertension. Early recognition allows the
nurse to implement bed rest, fluid and sodium restriction, and blood pressure monitoring during
the acute phase.
Q3: A newborn develops progressive jaundice at 3 weeks of age. The parents report dark tea-
colored urine and pale, clay-colored stools. Which condition should the nurse suspect?
A. Physiologic jaundice
B. Hemolytic disease of the newborn
C. Hypertrophic pyloric stenosis
D. Biliary atresia
Correct Answer: D
Rationale: Correct because biliary atresia is characterized by progressive obstruction of the
extrahepatic bile ducts that produces progressive jaundice beyond the neonatal period, dark tea-
colored urine from conjugated bilirubin excretion, and clay-colored acholic stools due to absent
bile pigment in the gastrointestinal tract. Physiologic jaundice resolves within 1 to 2 weeks, and
hypertrophic pyloric stenosis presents with projectile vomiting rather than cholestatic findings.
The nurse should anticipate diagnostic workup including elevated direct bilirubin and a HIDA
scan, followed by urgent hepatoportoenterostomy before 60 days of age.
Q4: A nurse is teaching parents of an infant with gastroesophageal reflux about feeding
interventions. Which instructions should the nurse include? Select all that apply.
A. Place the infant in a car seat immediately after feeding
B. Thicken formula with infant rice cereal as prescribed
C. Hold the infant upright for 30 minutes after every feeding
D. Offer large-volume feedings every 4 hours
E. Burp the infant frequently throughout the feeding
Correct Answer: B, C, E
Rationale: Correct because thickening formula with infant rice cereal reduces the volume of
gastric contents available for reflux, holding the infant upright for 30 minutes after feeding uses
gravity to minimize retrograde flow, and frequent burping decreases gastric distension that
exacerbates sphincter relaxation. Placing the infant in a car seat immediately after feeding
increases intra-abdominal pressure from slouching and worsens reflux, while large-volume
feedings overwhelm the gastric capacity and increase regurgitation. These evidence-based
, feeding interventions reduce aspiration risk and support adequate nutrition in infants with
gastroesophageal reflux.
Q5: A 4-week-old infant has projectile, non-bilious vomiting immediately after every feeding
and remains eager to eat. During the physical examination, which finding supports the suspected
diagnosis?
A. Palpable sausage-shaped mass in the left lower quadrant
B. Olive-shaped mass in the right upper quadrant
C. Board-like rigid abdomen with rebound tenderness
D. High-pitched tinkling bowel sounds diffusely
Correct Answer: B
Rationale: Correct because hypertrophic pyloric stenosis produces a palpable olive-shaped mass
in the right upper quadrant as the hypertrophied pyloric muscle becomes distended and palpable
during or after feeding when the stomach is full. A sausage-shaped mass in the left lower
quadrant suggests intussusception, a rigid board-like abdomen indicates peritonitis, and high-
pitched tinkling bowel sounds suggest bowel obstruction from other causes. Recognition of this
classic finding prompts surgical consultation for pyloromyotomy after correcting hypochloremic
metabolic alkalosis.
Q6: A 6-year-old with short stature is scheduled for growth hormone stimulation testing. Which
instruction is most important for the nurse to provide to the parents?
A. The child must remain NPO prior to the test
B. The child should eat a high-carbohydrate breakfast before arrival
C. Administer the prescribed growth hormone injection the night before
D. Encourage vigorous exercise on the morning of the test
Correct Answer: A
Rationale: Correct because growth hormone stimulation testing requires the child to be NPO
and fasting prior to administration of a stimulating agent such as levodopa or arginine, since food
intake alters baseline hormone levels and invalidates results. Blood samples are drawn at precise
30-minute intervals for 2 hours because growth hormone is secreted in pulsatile bursts rather
than steady states. The nurse must ensure fasting status, monitor for hypoglycemia if insulin-
induced hypoglycemia is used, and document the protocol to confirm growth hormone
deficiency.
