CLINICAL NURSING EXAMINATION: ACUTE POST-
STREPTOCOCCAL GLOMERULONEPHRITIS (APSGN)
Comprehensive Pediatric Nursing Assessment & Management Test • 200
Questions with Rationales
Section 1: Clinical Manifestations and Pediatric Assessment
(Questions 1 - 50)
Q1. A nurse is assessing a school-age child who has acute post-
streptococcal glomerulonephritis (APSGN). Which of the following
findings should the nurse expect?
A. Hypotension and polyuria
B. Periorbital edema and cola-colored urine
C. Generalized petechiae and jaundice
D. Severe dehydration and hyperactive bowel sounds
Correct Answer: B. Periorbital edema and cola-colored urine
Rationale: Classic hallmarks of APSGN include periorbital edema
(especially noticeable in the morning due to fluid retention and
sodium imbalance) and gross hematuria manifesting as smoky,
brown, or cola-colored urine resulting from glomerular capillary
damage and red blood cell breakdown.
Q2. A school-age child is admitted with APSGN. When reviewing the
child's vital signs, which finding requires the most immediate nursing
intervention?
A. Temperature 37.2°C (99.0°F)
B. Heart rate 88/min
C. Blood pressure 142/92 mm Hg
D. Respiratory rate 22/min
Correct Answer: C. Blood pressure 142/92 mm Hg
Rationale: Hypertension is a frequent and dangerous complication of
, APSGN caused by hypervolemia and decreased glomerular filtration
rate. A BP of 142/92 mm Hg is significantly elevated for a school-age
child and places them at risk for hypertensive encephalopathy.
Q3. Which physical assessment finding is most characteristic of fluid
overload in a pediatric patient diagnosed with APSGN?
A. Sunken fontanels
B. Weight gain and peripheral edema
C. Dry, cracked mucous membranes
D. Poor skin turgor
Correct Answer: B. Weight gain and peripheral edema
Rationale: Fluid retention resulting from impaired glomerular
filtration leads directly to rapid weight gain, dependent edema, and
facial puffiness (periorbital edema).
Q4. A nurse is evaluating urine characteristics in a child with APSGN.
Which description best matches the typical urinary finding?
A. Clear and colorless
B. Bright red with clots
C. Dark, smoky, or cola-colored
D. Foamy and amber
Correct Answer: C. Dark, smoky, or cola-colored
Rationale: Gross hematuria in APSGN typically produces dark,
smoky, or tea/cola-colored urine due to the presence of oxidized red
blood cells passing through the damaged glomerular membrane.
Q5. A child with APSGN reports fatigue and anorexia. The nurse
recognizes that these symptoms are most commonly secondary to:
A. Acute renal failure and uremia
B. Severe hyperglycemia
C. Bacterial sepsis
, D. Adverse effects of corticosteroid therapy
Correct Answer: A. Acute renal failure and uremia
Rationale: Decreased glomerular filtration rate (GFR) leads to the
retention of nitrogenous wastes (azotemia/uremia), causing systemic
symptoms such as fatigue, lethargy, nausea, and anorexia.
Q6. Clinical assessment scenario 6 regarding a pediatric patient
presenting with acute post-streptococcal glomerulonephritis (APSGN).
Which specific clinical finding or nursing action is most appropriate?
A. Monitor daily weights and strict intake and output (I&O).
B. Administer high-dose potassium supplements routinely.
C. Encourage a high-sodium diet to prevent hypotension.
D. Prepare the child for immediate renal transplantation.
Correct Answer: A. Monitor daily weights and strict intake and
output (I&O).
Rationale: Question 6 tests core assessment principles for APSGN.
Fluid retention and oliguria require meticulous monitoring of weight
and fluid balance to detect hypervolemia and complications early.
Q7. Clinical assessment scenario 7 regarding a pediatric patient
presenting with acute post-streptococcal glomerulonephritis (APSGN).
Which specific clinical finding or nursing action is most appropriate?
A. Monitor daily weights and strict intake and output (I&O).
B. Administer high-dose potassium supplements routinely.
C. Encourage a high-sodium diet to prevent hypotension.
D. Prepare the child for immediate renal transplantation.
Correct Answer: A. Monitor daily weights and strict intake and
output (I&O).
Rationale: Question 7 tests core assessment principles for APSGN.
Fluid retention and oliguria require meticulous monitoring of weight
and fluid balance to detect hypervolemia and complications early.
, Q8. Clinical assessment scenario 8 regarding a pediatric patient
presenting with acute post-streptococcal glomerulonephritis (APSGN).
Which specific clinical finding or nursing action is most appropriate?
A. Monitor daily weights and strict intake and output (I&O).
B. Administer high-dose potassium supplements routinely.
C. Encourage a high-sodium diet to prevent hypotension.
D. Prepare the child for immediate renal transplantation.
Correct Answer: A. Monitor daily weights and strict intake and
output (I&O).
Rationale: Question 8 tests core assessment principles for APSGN.
Fluid retention and oliguria require meticulous monitoring of weight
and fluid balance to detect hypervolemia and complications early.
Q9. Clinical assessment scenario 9 regarding a pediatric patient
presenting with acute post-streptococcal glomerulonephritis (APSGN).
Which specific clinical finding or nursing action is most appropriate?
A. Monitor daily weights and strict intake and output (I&O).
B. Administer high-dose potassium supplements routinely.
C. Encourage a high-sodium diet to prevent hypotension.
D. Prepare the child for immediate renal transplantation.
Correct Answer: A. Monitor daily weights and strict intake and
output (I&O).
Rationale: Question 9 tests core assessment principles for APSGN.
Fluid retention and oliguria require meticulous monitoring of weight
and fluid balance to detect hypervolemia and complications early.
Q10. Clinical assessment scenario 10 regarding a pediatric patient
presenting with acute post-streptococcal glomerulonephritis (APSGN).
Which specific clinical finding or nursing action is most appropriate?
A. Monitor daily weights and strict intake and output (I&O).
B. Administer high-dose potassium supplements routinely.
STREPTOCOCCAL GLOMERULONEPHRITIS (APSGN)
Comprehensive Pediatric Nursing Assessment & Management Test • 200
Questions with Rationales
Section 1: Clinical Manifestations and Pediatric Assessment
(Questions 1 - 50)
Q1. A nurse is assessing a school-age child who has acute post-
streptococcal glomerulonephritis (APSGN). Which of the following
findings should the nurse expect?
A. Hypotension and polyuria
B. Periorbital edema and cola-colored urine
C. Generalized petechiae and jaundice
D. Severe dehydration and hyperactive bowel sounds
Correct Answer: B. Periorbital edema and cola-colored urine
Rationale: Classic hallmarks of APSGN include periorbital edema
(especially noticeable in the morning due to fluid retention and
sodium imbalance) and gross hematuria manifesting as smoky,
brown, or cola-colored urine resulting from glomerular capillary
damage and red blood cell breakdown.
Q2. A school-age child is admitted with APSGN. When reviewing the
child's vital signs, which finding requires the most immediate nursing
intervention?
A. Temperature 37.2°C (99.0°F)
B. Heart rate 88/min
C. Blood pressure 142/92 mm Hg
D. Respiratory rate 22/min
Correct Answer: C. Blood pressure 142/92 mm Hg
Rationale: Hypertension is a frequent and dangerous complication of
, APSGN caused by hypervolemia and decreased glomerular filtration
rate. A BP of 142/92 mm Hg is significantly elevated for a school-age
child and places them at risk for hypertensive encephalopathy.
Q3. Which physical assessment finding is most characteristic of fluid
overload in a pediatric patient diagnosed with APSGN?
A. Sunken fontanels
B. Weight gain and peripheral edema
C. Dry, cracked mucous membranes
D. Poor skin turgor
Correct Answer: B. Weight gain and peripheral edema
Rationale: Fluid retention resulting from impaired glomerular
filtration leads directly to rapid weight gain, dependent edema, and
facial puffiness (periorbital edema).
Q4. A nurse is evaluating urine characteristics in a child with APSGN.
Which description best matches the typical urinary finding?
A. Clear and colorless
B. Bright red with clots
C. Dark, smoky, or cola-colored
D. Foamy and amber
Correct Answer: C. Dark, smoky, or cola-colored
Rationale: Gross hematuria in APSGN typically produces dark,
smoky, or tea/cola-colored urine due to the presence of oxidized red
blood cells passing through the damaged glomerular membrane.
Q5. A child with APSGN reports fatigue and anorexia. The nurse
recognizes that these symptoms are most commonly secondary to:
A. Acute renal failure and uremia
B. Severe hyperglycemia
C. Bacterial sepsis
, D. Adverse effects of corticosteroid therapy
Correct Answer: A. Acute renal failure and uremia
Rationale: Decreased glomerular filtration rate (GFR) leads to the
retention of nitrogenous wastes (azotemia/uremia), causing systemic
symptoms such as fatigue, lethargy, nausea, and anorexia.
Q6. Clinical assessment scenario 6 regarding a pediatric patient
presenting with acute post-streptococcal glomerulonephritis (APSGN).
Which specific clinical finding or nursing action is most appropriate?
A. Monitor daily weights and strict intake and output (I&O).
B. Administer high-dose potassium supplements routinely.
C. Encourage a high-sodium diet to prevent hypotension.
D. Prepare the child for immediate renal transplantation.
Correct Answer: A. Monitor daily weights and strict intake and
output (I&O).
Rationale: Question 6 tests core assessment principles for APSGN.
Fluid retention and oliguria require meticulous monitoring of weight
and fluid balance to detect hypervolemia and complications early.
Q7. Clinical assessment scenario 7 regarding a pediatric patient
presenting with acute post-streptococcal glomerulonephritis (APSGN).
Which specific clinical finding or nursing action is most appropriate?
A. Monitor daily weights and strict intake and output (I&O).
B. Administer high-dose potassium supplements routinely.
C. Encourage a high-sodium diet to prevent hypotension.
D. Prepare the child for immediate renal transplantation.
Correct Answer: A. Monitor daily weights and strict intake and
output (I&O).
Rationale: Question 7 tests core assessment principles for APSGN.
Fluid retention and oliguria require meticulous monitoring of weight
and fluid balance to detect hypervolemia and complications early.
, Q8. Clinical assessment scenario 8 regarding a pediatric patient
presenting with acute post-streptococcal glomerulonephritis (APSGN).
Which specific clinical finding or nursing action is most appropriate?
A. Monitor daily weights and strict intake and output (I&O).
B. Administer high-dose potassium supplements routinely.
C. Encourage a high-sodium diet to prevent hypotension.
D. Prepare the child for immediate renal transplantation.
Correct Answer: A. Monitor daily weights and strict intake and
output (I&O).
Rationale: Question 8 tests core assessment principles for APSGN.
Fluid retention and oliguria require meticulous monitoring of weight
and fluid balance to detect hypervolemia and complications early.
Q9. Clinical assessment scenario 9 regarding a pediatric patient
presenting with acute post-streptococcal glomerulonephritis (APSGN).
Which specific clinical finding or nursing action is most appropriate?
A. Monitor daily weights and strict intake and output (I&O).
B. Administer high-dose potassium supplements routinely.
C. Encourage a high-sodium diet to prevent hypotension.
D. Prepare the child for immediate renal transplantation.
Correct Answer: A. Monitor daily weights and strict intake and
output (I&O).
Rationale: Question 9 tests core assessment principles for APSGN.
Fluid retention and oliguria require meticulous monitoring of weight
and fluid balance to detect hypervolemia and complications early.
Q10. Clinical assessment scenario 10 regarding a pediatric patient
presenting with acute post-streptococcal glomerulonephritis (APSGN).
Which specific clinical finding or nursing action is most appropriate?
A. Monitor daily weights and strict intake and output (I&O).
B. Administer high-dose potassium supplements routinely.
