Galen NSG 3600
Exam 3 – Child Health
Pediatric Nursing Comprehensive Exam Bank
2026/2027 Academic Year
65 NCLEX-Style Practice Questions with Rationales
,Gastrointestinal Disorders – Part 1
16 Questions
1. A 4-week-old infant is brought to the pediatric clinic by the parents who report that the baby has been
vomiting after every feeding for the past week. The nurse observes that the emesis is forceful and projects
across the crib. Which finding would the nurse expect to assess that is most consistent with pyloric
stenosis?
A) An olive-shaped mass in the right upper quadrant
B) Bilious green-tinged emesis with abdominal distension
C) Hypoactive bowel sounds and ribbon-like stools
D) Visible peristaltic waves moving from right to left across the abdomen
Rationale: An olive-shaped mass in the right upper quadrant is the classic palpable finding of hypertrophic
pyloric stenosis caused by the thickened pyloric muscle. Projectile non-bilious vomiting is the hallmark
symptom, but bilious emesis (option B) suggests an intestinal obstruction distal to the pylorus, not pyloric
stenosis. Ribbon-like stools (option C) are associated with Hirschsprung disease. Visible peristaltic waves do
occur in pyloric stenosis but move from left to right (option D), not right to left, as the stomach attempts to push
contents through the narrowed pylorus.
2. The nurse is reviewing laboratory results for a 5-week-old infant admitted with suspected pyloric
stenosis who has been vomiting for 10 days. Which laboratory finding would the nurse anticipate?
A) Hyperchloremic metabolic acidosis with elevated potassium
B) Hypochloremic metabolic alkalosis with low potassium
C) Metabolic acidosis with elevated bicarbonate and low sodium
D) Respiratory alkalosis with elevated chloride and normal potassium
Rationale: Prolonged vomiting of gastric contents rich in hydrochloric acid and chloride leads to hypochloremic
metabolic alkalosis. The kidneys attempt to conserve hydrogen ions by exchanging them for potassium in the
distal tubule, resulting in hypokalemia. This combination — hypochloremia, hypokalemia, and metabolic
alkalosis — is the classic metabolic derangement of pyloric stenosis. Options A, C, and D describe acid-base
imbalances inconsistent with the loss of gastric acid seen in this condition.
3. A 6-week-old infant is scheduled for a pyloromyotomy. The nurse has completed preoperative
preparation. Which intervention is most important for the nurse to implement in the immediate
preoperative period?
A) Administer a prescribed proton pump inhibitor 30 minutes before surgery
B) Position the infant supine with the head of the bed flat to prevent aspiration
C) Apply a warm compress to the abdomen to promote comfort and reduce vomiting
D) Maintain NPO status and ensure a functioning intravenous line with appropriate fluids
Rationale: Maintaining NPO status is critical to reduce the risk of aspiration during anesthesia induction, and a
functioning IV line is essential for administering fluids (typically normal saline with potassium chloride) to
correct the dehydration and electrolyte imbalances caused by persistent vomiting. PPIs (option A) are not the
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, priority preoperative intervention for pyloric stenosis. Positioning supine with the head flat (option B) actually
increases aspiration risk; the infant should be positioned with the head elevated. Warm compresses (option C)
provide comfort but are not the priority preoperatively.
4. An infant has returned to the pediatric unit following a laparoscopic pyloromyotomy. The physician
has ordered small, frequent feedings of glucose water. Which statement by the nurse indicates an
understanding of the expected postoperative feeding progression?
A) I will advance to formula or breast milk once the infant tolerates glucose water without
vomiting.
B) I will begin with full-strength formula immediately and monitor for signs of dumping syndrome.
C) I will continue glucose water feedings for 24 hours and then advance to half-strength formula.
D) I will wait until bowel sounds return before initiating any oral intake.
Rationale: After pyloromyotomy, feedings typically begin with small amounts of glucose water or an electrolyte
solution. If the infant tolerates this without vomiting, feedings are advanced to breast milk or formula in
increasing volumes. Beginning with full-strength formula (option B) is too aggressive and increases the risk of
postoperative vomiting. Delaying feeding for 24 hours (option C) is unnecessarily prolonged; early small feeds
are the standard of care. Waiting for bowel sounds (option D) is not required after pyloromyotomy because the
surgery is on the stomach outlet, not the intestines.
5. An 8-month-old male infant is brought to the emergency department with episodes of sudden, high-
pitched crying, drawing the knees to the chest. Between episodes the infant appears pale and lethargic.
The parents report that the infant passed a stool that appeared dark red and jelly-like. Which diagnostic
test should the nurse prepare the infant for?
A) Upper GI series with barium contrast
B) Lower endoscopy to visualize the intestinal mucosa
C) Abdominal ultrasound to identify a target sign
D) CT scan of the abdomen with oral contrast
Rationale: The classic triad of intermittent colicky abdominal pain, currant jelly stools, and a palpable sausage-
shaped mass is pathognomonic for intussusception — the telescoping of one bowel segment into another.
Abdominal ultrasound is the preferred initial diagnostic tool and will show a characteristic target sign (or
doughnut sign) on cross-section, representing the layers of the intussuscepted bowel. Upper GI series (option A)
is used for suspected malrotation or pyloric stenosis. CT scan (option D) exposes the infant to unnecessary
radiation when ultrasound is diagnostic. Lower endoscopy (option B) is not the diagnostic study of choice for
intussusception.
6. A 10-month-old infant has been diagnosed with intussusception. The pediatric surgeon plans a
therapeutic air contrast enema. Which nursing intervention is most critical before the procedure?
A) Obtain informed consent and ensure the infant has a functioning IV line
B) Administer a prophylactic broad-spectrum antibiotic intravenously
C) Insert a nasogastric tube and connect it to continuous suction
D) Assess the infant for allergies to barium sulfate contrast material
Rationale: Air contrast enema serves as both a diagnostic and therapeutic procedure for intussusception.
Informed consent is required because the procedure carries risks including bowel perforation. A functioning IV
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Exam 3 – Child Health
Pediatric Nursing Comprehensive Exam Bank
2026/2027 Academic Year
65 NCLEX-Style Practice Questions with Rationales
,Gastrointestinal Disorders – Part 1
16 Questions
1. A 4-week-old infant is brought to the pediatric clinic by the parents who report that the baby has been
vomiting after every feeding for the past week. The nurse observes that the emesis is forceful and projects
across the crib. Which finding would the nurse expect to assess that is most consistent with pyloric
stenosis?
A) An olive-shaped mass in the right upper quadrant
B) Bilious green-tinged emesis with abdominal distension
C) Hypoactive bowel sounds and ribbon-like stools
D) Visible peristaltic waves moving from right to left across the abdomen
Rationale: An olive-shaped mass in the right upper quadrant is the classic palpable finding of hypertrophic
pyloric stenosis caused by the thickened pyloric muscle. Projectile non-bilious vomiting is the hallmark
symptom, but bilious emesis (option B) suggests an intestinal obstruction distal to the pylorus, not pyloric
stenosis. Ribbon-like stools (option C) are associated with Hirschsprung disease. Visible peristaltic waves do
occur in pyloric stenosis but move from left to right (option D), not right to left, as the stomach attempts to push
contents through the narrowed pylorus.
2. The nurse is reviewing laboratory results for a 5-week-old infant admitted with suspected pyloric
stenosis who has been vomiting for 10 days. Which laboratory finding would the nurse anticipate?
A) Hyperchloremic metabolic acidosis with elevated potassium
B) Hypochloremic metabolic alkalosis with low potassium
C) Metabolic acidosis with elevated bicarbonate and low sodium
D) Respiratory alkalosis with elevated chloride and normal potassium
Rationale: Prolonged vomiting of gastric contents rich in hydrochloric acid and chloride leads to hypochloremic
metabolic alkalosis. The kidneys attempt to conserve hydrogen ions by exchanging them for potassium in the
distal tubule, resulting in hypokalemia. This combination — hypochloremia, hypokalemia, and metabolic
alkalosis — is the classic metabolic derangement of pyloric stenosis. Options A, C, and D describe acid-base
imbalances inconsistent with the loss of gastric acid seen in this condition.
3. A 6-week-old infant is scheduled for a pyloromyotomy. The nurse has completed preoperative
preparation. Which intervention is most important for the nurse to implement in the immediate
preoperative period?
A) Administer a prescribed proton pump inhibitor 30 minutes before surgery
B) Position the infant supine with the head of the bed flat to prevent aspiration
C) Apply a warm compress to the abdomen to promote comfort and reduce vomiting
D) Maintain NPO status and ensure a functioning intravenous line with appropriate fluids
Rationale: Maintaining NPO status is critical to reduce the risk of aspiration during anesthesia induction, and a
functioning IV line is essential for administering fluids (typically normal saline with potassium chloride) to
correct the dehydration and electrolyte imbalances caused by persistent vomiting. PPIs (option A) are not the
Page PAGE
, priority preoperative intervention for pyloric stenosis. Positioning supine with the head flat (option B) actually
increases aspiration risk; the infant should be positioned with the head elevated. Warm compresses (option C)
provide comfort but are not the priority preoperatively.
4. An infant has returned to the pediatric unit following a laparoscopic pyloromyotomy. The physician
has ordered small, frequent feedings of glucose water. Which statement by the nurse indicates an
understanding of the expected postoperative feeding progression?
A) I will advance to formula or breast milk once the infant tolerates glucose water without
vomiting.
B) I will begin with full-strength formula immediately and monitor for signs of dumping syndrome.
C) I will continue glucose water feedings for 24 hours and then advance to half-strength formula.
D) I will wait until bowel sounds return before initiating any oral intake.
Rationale: After pyloromyotomy, feedings typically begin with small amounts of glucose water or an electrolyte
solution. If the infant tolerates this without vomiting, feedings are advanced to breast milk or formula in
increasing volumes. Beginning with full-strength formula (option B) is too aggressive and increases the risk of
postoperative vomiting. Delaying feeding for 24 hours (option C) is unnecessarily prolonged; early small feeds
are the standard of care. Waiting for bowel sounds (option D) is not required after pyloromyotomy because the
surgery is on the stomach outlet, not the intestines.
5. An 8-month-old male infant is brought to the emergency department with episodes of sudden, high-
pitched crying, drawing the knees to the chest. Between episodes the infant appears pale and lethargic.
The parents report that the infant passed a stool that appeared dark red and jelly-like. Which diagnostic
test should the nurse prepare the infant for?
A) Upper GI series with barium contrast
B) Lower endoscopy to visualize the intestinal mucosa
C) Abdominal ultrasound to identify a target sign
D) CT scan of the abdomen with oral contrast
Rationale: The classic triad of intermittent colicky abdominal pain, currant jelly stools, and a palpable sausage-
shaped mass is pathognomonic for intussusception — the telescoping of one bowel segment into another.
Abdominal ultrasound is the preferred initial diagnostic tool and will show a characteristic target sign (or
doughnut sign) on cross-section, representing the layers of the intussuscepted bowel. Upper GI series (option A)
is used for suspected malrotation or pyloric stenosis. CT scan (option D) exposes the infant to unnecessary
radiation when ultrasound is diagnostic. Lower endoscopy (option B) is not the diagnostic study of choice for
intussusception.
6. A 10-month-old infant has been diagnosed with intussusception. The pediatric surgeon plans a
therapeutic air contrast enema. Which nursing intervention is most critical before the procedure?
A) Obtain informed consent and ensure the infant has a functioning IV line
B) Administer a prophylactic broad-spectrum antibiotic intravenously
C) Insert a nasogastric tube and connect it to continuous suction
D) Assess the infant for allergies to barium sulfate contrast material
Rationale: Air contrast enema serves as both a diagnostic and therapeutic procedure for intussusception.
Informed consent is required because the procedure carries risks including bowel perforation. A functioning IV
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