NUR 257: ADVANCED PEDIATRIC
NURSING PRACTICE EXAM QUESTIONS
AND ANSWERS WITH VERIFIED
SOLUTIONS 2026/2027 UPDATE
1. A 4-month-old infant is admitted with Tetralogy of Fallot. During a blood draw, the infant
becomes cyanotic and tachypneic. Which action should the nurse perform first?
A. Administer 100% oxygen via face mask
B. Place the infant in a knee-chest position
C. Prepare a dose of intravenous morphine
D. Call the rapid response team
Answer: B
Conceptual Explanation: The knee-chest position increases systemic vascular resistance,
which helps reduce the right-to-left shunt across the ventricular septal defect, thereby
improving oxygenation during a ‘tet spell’.
2. A child is diagnosed with Nephrotic Syndrome. Which laboratory finding would the nurse
most likely expect to observe?
A. Hypolipidemia and hypertension
B. Gross hematuria and decreased BUN
,C. Hypernatremia and metabolic alkalosis
D. Hypoalbuminemia and massive proteinuria
Answer: D
Conceptual Explanation: Nephrotic syndrome is characterized by massive proteinuria,
hypoalbuminemia, edema, and hyperlipidemia due to increased glomerular permeability.
3. A 6-year-old with Cystic Fibrosis is receiving pancrelipase. How should the nurse instruct
the parents to administer this medication?
A. Once daily in the morning before breakfast
B. Only if the child has a fatty stool
C. With all meals and snacks
D. Two hours after meals to ensure absorption
Answer: C
Conceptual Explanation: Pancreatic enzymes must be taken with every meal and snack to
facilitate the digestion and absorption of fats, proteins, and carbohydrates in children with
Cystic Fibrosis.
4. A nurse is assessing a 3-week-old infant suspected of having Hypertrophic Pyloric Stenosis.
Which finding is a hallmark of this condition?
A. Bile-stained emesis after every feeding
B. Currant jelly-like stools
, C. An olive-shaped mass in the right epigastrium
D. Ribbon-like, foul-smelling stools
Answer: C
Conceptual Explanation: Pyloric stenosis is characterized by projectile non-bilious
vomiting and a palpable olive-shaped mass in the right upper quadrant or epigastrium.
5. A toddler is hospitalized with Kawasaki Disease. Which medication order should the nurse
question?
A. Intravenous Immunoglobulin (IVIG)
B. High-dose Aspirin therapy
C. Warfarin for long-term anticoagulation
D. Live virus Varicella vaccine upon discharge
Answer: D
Conceptual Explanation: Live vaccines (like MMR and Varicella) should be delayed for 11
months after IVIG administration because the antibodies in IVIG can interfere with the
immune response to the vaccine.
6. A school-aged child with Sickle Cell Anemia is admitted in a vaso-occlusive crisis. What is
the priority nursing intervention?
A. Encouraging a high-protein diet
B. Administering Heparin to prevent further clotting
NURSING PRACTICE EXAM QUESTIONS
AND ANSWERS WITH VERIFIED
SOLUTIONS 2026/2027 UPDATE
1. A 4-month-old infant is admitted with Tetralogy of Fallot. During a blood draw, the infant
becomes cyanotic and tachypneic. Which action should the nurse perform first?
A. Administer 100% oxygen via face mask
B. Place the infant in a knee-chest position
C. Prepare a dose of intravenous morphine
D. Call the rapid response team
Answer: B
Conceptual Explanation: The knee-chest position increases systemic vascular resistance,
which helps reduce the right-to-left shunt across the ventricular septal defect, thereby
improving oxygenation during a ‘tet spell’.
2. A child is diagnosed with Nephrotic Syndrome. Which laboratory finding would the nurse
most likely expect to observe?
A. Hypolipidemia and hypertension
B. Gross hematuria and decreased BUN
,C. Hypernatremia and metabolic alkalosis
D. Hypoalbuminemia and massive proteinuria
Answer: D
Conceptual Explanation: Nephrotic syndrome is characterized by massive proteinuria,
hypoalbuminemia, edema, and hyperlipidemia due to increased glomerular permeability.
3. A 6-year-old with Cystic Fibrosis is receiving pancrelipase. How should the nurse instruct
the parents to administer this medication?
A. Once daily in the morning before breakfast
B. Only if the child has a fatty stool
C. With all meals and snacks
D. Two hours after meals to ensure absorption
Answer: C
Conceptual Explanation: Pancreatic enzymes must be taken with every meal and snack to
facilitate the digestion and absorption of fats, proteins, and carbohydrates in children with
Cystic Fibrosis.
4. A nurse is assessing a 3-week-old infant suspected of having Hypertrophic Pyloric Stenosis.
Which finding is a hallmark of this condition?
A. Bile-stained emesis after every feeding
B. Currant jelly-like stools
, C. An olive-shaped mass in the right epigastrium
D. Ribbon-like, foul-smelling stools
Answer: C
Conceptual Explanation: Pyloric stenosis is characterized by projectile non-bilious
vomiting and a palpable olive-shaped mass in the right upper quadrant or epigastrium.
5. A toddler is hospitalized with Kawasaki Disease. Which medication order should the nurse
question?
A. Intravenous Immunoglobulin (IVIG)
B. High-dose Aspirin therapy
C. Warfarin for long-term anticoagulation
D. Live virus Varicella vaccine upon discharge
Answer: D
Conceptual Explanation: Live vaccines (like MMR and Varicella) should be delayed for 11
months after IVIG administration because the antibodies in IVIG can interfere with the
immune response to the vaccine.
6. A school-aged child with Sickle Cell Anemia is admitted in a vaso-occlusive crisis. What is
the priority nursing intervention?
A. Encouraging a high-protein diet
B. Administering Heparin to prevent further clotting
