NR 328 PEDIATRIC NURSING - COMPREHENSIVE FINAL
EXAM GUIDE (125 Questions answers and rationales)
Chamberlain University - NR 328: Pediatric Nursing
Comprehensive Practice & Review Guide
--------------------------------------------------------------------------------
📋 Gastrointestinal Disorders (Pyloric Stenosis, Intussusception, Cleft
Lip/Palate)
Q1. What is the classic clinical manifestation of hypertrophic pyloric stenosis?
Correct Answer: Projectile, non-bilious vomiting after feedings.
Rationale: The thickening of the pyloric sphincter causes an absolute obstruction, resulting
in forceful projectile vomiting and a palpable olive-shaped mass.
Q2. A mother describes her infant's stool as resembling 'current jelly.' What condition
does this suggest?
Correct Answer: Intussusception.
Rationale: Intussusception involves telescoping of the bowel, leading to ischemia, mucus
production, and blood leakage, giving stools a currant-jelly appearance.
Q3. What is the preferred non-surgical intervention to reduce intussusception in infants?
Correct Answer: Air or hydrostatic (barium/saline) enema.
Rationale: The pressure exerted by an air or fluid enema frequently forces the telescoped
bowel back into its normal anatomical position.
Q4. What is a primary post-operative nursing intervention following a cleft lip repair
(cheiloplasty)?
Correct Answer: Maintain the surgical line, use a Logan bow or elbow restraints, and
avoid placing objects in the mouth.
Rationale: Protecting the suture line from trauma and tension is critical for proper cosmetic
and functional healing.
Q5. What is a primary assessment finding in a child with Hirschsprung's disease?
Correct Answer: Failure to pass meconium within the first 24-48 hours, ribbon-like
stools, and abdominal distension.
Rationale: Hirschsprung's is characterized by aganglionic segments of the colon, preventing
normal peristalsis and causing functional obstruction.
📋 Genitourinary & Endocrine (Nephrotic Syndrome, Acute
Glomerulonephritis, Type 1 DM)
,Q6. What are the hallmark clinical manifestations of Nephrotic Syndrome?
Correct Answer: Severe proteinuria, hypoalbuminemia, hyperlipidemia, and
generalized edema.
Rationale: Glomerular damage increases permeability to proteins, draining intravascular
volume and causing massive fluid shifts (anasarca).
Q7. What is the primary medication class used to induce remission in a child with
Nephrotic Syndrome?
Correct Answer: Corticosteroids (Prednisone).
Rationale: Steroids reduce glomerular inflammation and stop proteinuria, reversing the
syndrome's pathology.
Q8. What historical finding is highly associated with Acute Post-Streptococcal
Glomerulonephritis (APSGN)?
Correct Answer: A recent group A beta-hemolytic streptococcal infection (pharyngitis
or impetigo) 1-2 weeks prior.
Rationale: APSGN is an immune-complex mediated disease that follows an inadequately
treated strep infection.
Q9. What is a key dietary restriction for a child admitted with Acute Glomerulonephritis?
Correct Answer: Fluid restriction and low sodium diet.
Rationale: Impaired glomerular filtration leads to fluid retention, hypertension, and gross
hematuria (tea-colored urine).
Q10. What are the classic symptoms of a child presenting with new-onset Type 1
Diabetes Mellitus?
Correct Answer: Polyuria, polydipsia, and polyphagia accompanied by unexplained
weight loss.
Rationale: Insulin deficiency prevents glucose utilization, leading to cellular starvation and
osmotic diuresis.
📋 Cardiovascular Defects (Congenital Defects, Tetralogy of Fallot,
Rheumatic Fever)
Q11. What four congenital heart defects comprise the Tetralogy of Fallot?
Correct Answer: Ventricular septal defect (VSD), Pulmonic stenosis, Overriding aorta,
and Right ventricular hypertrophy.
Rationale: These four anomalies cause severe deoxygenated blood mixing and decreased
pulmonary blood flow.
Q12. What immediate nursing action should be taken when an infant experiences a
hypercyanotic 'Tet' spell?
Correct Answer: Place the infant in a knee-chest position.
, Rationale: The knee-chest position increases systemic vascular resistance, forcing more
blood through the pulmonary artery to improve oxygenation.
Q13. What medication is administered to keep the ductus arteriosus patent in a newborn
with transposition of the great arteries?
Correct Answer: Prostaglandin E1 (Alprostadil) infusion.
Rationale: Maintaining a patent ductus arteriosus (PDA) allows essential mixing of blood to
sustain systemic oxygenation before surgical correction.
Q14. What is a major clinical manifestation of Kawasaki Disease during the acute phase?
Correct Answer: High persistent fever, strawberry tongue, dry cracked lips, and
bilateral conjunctival injection without exudate.
Rationale: Kawasaki disease is an acute systemic vasculitis that places the child at high risk
for coronary artery aneurysms.
📋 Neurological & Musculoskeletal (Meningitis, Spina Bifida, Cerebral
Palsy, Hip Dysplasia)
Q15. What sign is positive when a child's leg cannot be fully extended when the hip is
flexed at 90 degrees due to pain?
Correct Answer: Kernig's sign.
Rationale: Kernig's sign indicates meningeal irritation, common in bacterial meningitis.
Q16. What position should a newborn with an unrepaired myelomeningocele (Spina
Bifida) be placed in?
Correct Answer: Prone position with a sterile, moist, non-adherent dressing over the
sac.
Rationale: Prone positioning prevents trauma, pressure, and contamination of the exposed
spinal cord sac to reduce infection risks.
Q17. What diagnostic test confirms a diagnosis of bacterial meningitis?
Correct Answer: Lumbar puncture showing cloudy CSF, elevated protein, decreased
glucose, and elevated WBCs.
Rationale: Bacteria consume glucose and produce proteins, giving CSF a cloudy
appearance and altered lab values.
Q18. What is a positive Ortolani sign indicative of during an infant assessment?
Correct Answer: Developmental Dysplasia of the Hip (DDH).
Rationale: The Ortolani maneuver clunks the dislocated femoral head back into the
acetabulum, indicating hip instability.
📋 Advanced Pediatric Nursing Concepts (Final Comprehensive Block)
EXAM GUIDE (125 Questions answers and rationales)
Chamberlain University - NR 328: Pediatric Nursing
Comprehensive Practice & Review Guide
--------------------------------------------------------------------------------
📋 Gastrointestinal Disorders (Pyloric Stenosis, Intussusception, Cleft
Lip/Palate)
Q1. What is the classic clinical manifestation of hypertrophic pyloric stenosis?
Correct Answer: Projectile, non-bilious vomiting after feedings.
Rationale: The thickening of the pyloric sphincter causes an absolute obstruction, resulting
in forceful projectile vomiting and a palpable olive-shaped mass.
Q2. A mother describes her infant's stool as resembling 'current jelly.' What condition
does this suggest?
Correct Answer: Intussusception.
Rationale: Intussusception involves telescoping of the bowel, leading to ischemia, mucus
production, and blood leakage, giving stools a currant-jelly appearance.
Q3. What is the preferred non-surgical intervention to reduce intussusception in infants?
Correct Answer: Air or hydrostatic (barium/saline) enema.
Rationale: The pressure exerted by an air or fluid enema frequently forces the telescoped
bowel back into its normal anatomical position.
Q4. What is a primary post-operative nursing intervention following a cleft lip repair
(cheiloplasty)?
Correct Answer: Maintain the surgical line, use a Logan bow or elbow restraints, and
avoid placing objects in the mouth.
Rationale: Protecting the suture line from trauma and tension is critical for proper cosmetic
and functional healing.
Q5. What is a primary assessment finding in a child with Hirschsprung's disease?
Correct Answer: Failure to pass meconium within the first 24-48 hours, ribbon-like
stools, and abdominal distension.
Rationale: Hirschsprung's is characterized by aganglionic segments of the colon, preventing
normal peristalsis and causing functional obstruction.
📋 Genitourinary & Endocrine (Nephrotic Syndrome, Acute
Glomerulonephritis, Type 1 DM)
,Q6. What are the hallmark clinical manifestations of Nephrotic Syndrome?
Correct Answer: Severe proteinuria, hypoalbuminemia, hyperlipidemia, and
generalized edema.
Rationale: Glomerular damage increases permeability to proteins, draining intravascular
volume and causing massive fluid shifts (anasarca).
Q7. What is the primary medication class used to induce remission in a child with
Nephrotic Syndrome?
Correct Answer: Corticosteroids (Prednisone).
Rationale: Steroids reduce glomerular inflammation and stop proteinuria, reversing the
syndrome's pathology.
Q8. What historical finding is highly associated with Acute Post-Streptococcal
Glomerulonephritis (APSGN)?
Correct Answer: A recent group A beta-hemolytic streptococcal infection (pharyngitis
or impetigo) 1-2 weeks prior.
Rationale: APSGN is an immune-complex mediated disease that follows an inadequately
treated strep infection.
Q9. What is a key dietary restriction for a child admitted with Acute Glomerulonephritis?
Correct Answer: Fluid restriction and low sodium diet.
Rationale: Impaired glomerular filtration leads to fluid retention, hypertension, and gross
hematuria (tea-colored urine).
Q10. What are the classic symptoms of a child presenting with new-onset Type 1
Diabetes Mellitus?
Correct Answer: Polyuria, polydipsia, and polyphagia accompanied by unexplained
weight loss.
Rationale: Insulin deficiency prevents glucose utilization, leading to cellular starvation and
osmotic diuresis.
📋 Cardiovascular Defects (Congenital Defects, Tetralogy of Fallot,
Rheumatic Fever)
Q11. What four congenital heart defects comprise the Tetralogy of Fallot?
Correct Answer: Ventricular septal defect (VSD), Pulmonic stenosis, Overriding aorta,
and Right ventricular hypertrophy.
Rationale: These four anomalies cause severe deoxygenated blood mixing and decreased
pulmonary blood flow.
Q12. What immediate nursing action should be taken when an infant experiences a
hypercyanotic 'Tet' spell?
Correct Answer: Place the infant in a knee-chest position.
, Rationale: The knee-chest position increases systemic vascular resistance, forcing more
blood through the pulmonary artery to improve oxygenation.
Q13. What medication is administered to keep the ductus arteriosus patent in a newborn
with transposition of the great arteries?
Correct Answer: Prostaglandin E1 (Alprostadil) infusion.
Rationale: Maintaining a patent ductus arteriosus (PDA) allows essential mixing of blood to
sustain systemic oxygenation before surgical correction.
Q14. What is a major clinical manifestation of Kawasaki Disease during the acute phase?
Correct Answer: High persistent fever, strawberry tongue, dry cracked lips, and
bilateral conjunctival injection without exudate.
Rationale: Kawasaki disease is an acute systemic vasculitis that places the child at high risk
for coronary artery aneurysms.
📋 Neurological & Musculoskeletal (Meningitis, Spina Bifida, Cerebral
Palsy, Hip Dysplasia)
Q15. What sign is positive when a child's leg cannot be fully extended when the hip is
flexed at 90 degrees due to pain?
Correct Answer: Kernig's sign.
Rationale: Kernig's sign indicates meningeal irritation, common in bacterial meningitis.
Q16. What position should a newborn with an unrepaired myelomeningocele (Spina
Bifida) be placed in?
Correct Answer: Prone position with a sterile, moist, non-adherent dressing over the
sac.
Rationale: Prone positioning prevents trauma, pressure, and contamination of the exposed
spinal cord sac to reduce infection risks.
Q17. What diagnostic test confirms a diagnosis of bacterial meningitis?
Correct Answer: Lumbar puncture showing cloudy CSF, elevated protein, decreased
glucose, and elevated WBCs.
Rationale: Bacteria consume glucose and produce proteins, giving CSF a cloudy
appearance and altered lab values.
Q18. What is a positive Ortolani sign indicative of during an infant assessment?
Correct Answer: Developmental Dysplasia of the Hip (DDH).
Rationale: The Ortolani maneuver clunks the dislocated femoral head back into the
acetabulum, indicating hip instability.
📋 Advanced Pediatric Nursing Concepts (Final Comprehensive Block)
