NUR 203 /NUR203 Exam 2 Pediatric Nursing
2026/2027/2028 Testing Cycle | Newly Released
50 Questions With Answers & Expert Rationales
Guaranteed Pass | Graded A+ | Fortis College
Complex Pediatric Illness – Respiratory, Cardiac, Hematology, &
Neurodevelopmental Disorders
Q1: A 6-month-old infant with cystic fibrosis is receiving pancreatic enzyme replacement
therapy. The nurse observes that the mother is mixing the enzyme powder with formula and
feeding it immediately. Which action should the nurse take?
A. Instruct the mother to increase the dose because formula neutralizes the enzyme
B. Tell the mother to mix the powder with hot water to improve dissolution
C. Teach the mother to administer the enzymes 30 minutes before each feeding
D. Advise the mother to crush the enteric-coated beads for better absorption
Correct Answer: C
Rationale: Correct because pancreatic enzymes must be administered 30 minutes before all
meals and snacks to ensure optimal fat and protein absorption in the duodenum. Administering
enzymes with or after meals allows food to pass through the small intestine before adequate
enzyme activity occurs, leading to malabsorption and steatorrhea. Hot water and crushing
enteric-coated beads destroy the protective coating and cause oral mucosal damage, while
increasing the dose does not compensate for incorrect timing.
Q2: A nurse is assessing a newborn and auscultates a harsh, machine-like murmur that is
continuous throughout systole and diastole at the left upper sternal border. The nurse recognizes
this as characteristic of which congenital heart defect?
A. Patent ductus arteriosus
B. Ventricular septal defect
C. Atrial septal defect
D. Tetralogy of Fallot
,Correct Answer: A
Rationale: Correct because a harsh, machine-like murmur that is continuous throughout both
systole and diastole is the hallmark auscultatory finding of patent ductus arteriosus, resulting
from turbulent blood flow through the persistently open ductus between the aorta and pulmonary
artery. Ventricular septal defect produces a harsh holosystolic murmur, atrial septal defect creates
a fixed split S2 with a systolic murmur, and Tetralogy of Fallot presents with a systolic ejection
murmur due to pulmonary stenosis.
Q3: A nurse is conducting a developmental screening on a 2-year-old child. Which findings are
consistent with autism spectrum disorder? Select all that apply.
A. Avoidant or abnormal eye contact
B. Lack of response when called by name
C. Engaging in reciprocal pretend play with peers
D. Repetitive hand-flapping movements
E. Severe aversion to loud noises
Correct Answer: A, B, D, E
Rationale: Correct because autism spectrum disorder is characterized by persistent deficits in
social communication and interaction, including avoidant eye contact, failure to respond to one's
own name, and restricted repetitive behaviors such as hand-flapping and sensory hyperreactivity
to auditory stimuli. Engaging in reciprocal pretend play with peers represents typical social
development and is not consistent with ASD, which features decreased social reciprocity and a
preference for solitary play. Early identification of these hallmark signs allows for referral to
early intervention services, which significantly improve long-term developmental outcomes.
Q4: A 7-year-old child with sickle cell anemia is admitted with severe joint pain in both knees.
The child rates the pain as 8 out of 10. Which intervention should the nurse implement first?
A. Apply ice packs to both knees to reduce inflammation
B. Encourage the child to ambulate to prevent joint stiffness
C. Administer oral acetaminophen and reassess in 2 hours
D. Administer scheduled opioid analgesics and initiate aggressive IV hydration
Correct Answer: D
Rationale: Correct because the priority nursing interventions for a vaso-occlusive sickle cell
crisis include aggressive pain management with scheduled opioid analgesics and vigorous IV
hydration to reduce blood viscosity and promote perfusion to ischemic tissues. Ice application
causes vasoconstriction and worsens vaso-occlusion, while acetaminophen lacks the potency
, required for severe crisis pain. Early mobilization is inappropriate during acute pain and may
increase metabolic demands and tissue hypoxia.
Q5: A 3-year-old child with severe asthma is brought to the emergency department with audible
wheezing, intercostal retractions, and an SpO₂ of 89%. Which assessment finding indicates the
child is deteriorating and requires immediate intervention?
A. Decreased respiratory rate from 40 to 28 breaths per minute
B. Absence of wheezing with decreased breath sounds bilaterally
C. Improved color from cyanotic to pink
D. Decreased heart rate from 160 to 140 bpm
Correct Answer: B
Rationale: Correct because the sudden absence of wheezing accompanied by decreased breath
sounds bilaterally indicates severe airway obstruction and impending respiratory failure due to
insufficient air movement to produce sound. This silent chest finding is a medical emergency
requiring immediate preparation for intubation and mechanical ventilation. A decreased
respiratory rate in a distressed child may represent fatigue rather than improvement, and while
color improvement is positive, the loss of audible breath sounds signals critical decompensation.
Q6: A newborn with transposition of the great arteries is receiving continuous IV prostaglandin
E1. The parents ask why this medication is necessary. Which explanation by the nurse is most
accurate?
A. "It reduces pulmonary vascular resistance to improve blood flow."
B. "It strengthens the heart muscle until surgery can be performed."
C. "It keeps the ductus arteriosus open to allow mixing of oxygenated and unoxygenated blood."
D. "It prevents infection until the arterial switch operation is scheduled."
Correct Answer: C
Rationale: Correct because prostaglandin E1 maintains patency of the ductus arteriosus, which
is essential for survival in transposition of the great arteries by allowing mixing between the
parallel pulmonary and systemic circulations. Without PGE1, the ductus would close, resulting in
two separate non-communicating circuits and rapid deterioration. The medication does not
reduce pulmonary vascular resistance, strengthen myocardium, or provide antimicrobial
prophylaxis.
Q7: Order: Pancrelipase 500 units/kg per meal. The child weighs 16 kg. How many units of
pancrelipase should the nurse administer per meal? ______ units
2026/2027/2028 Testing Cycle | Newly Released
50 Questions With Answers & Expert Rationales
Guaranteed Pass | Graded A+ | Fortis College
Complex Pediatric Illness – Respiratory, Cardiac, Hematology, &
Neurodevelopmental Disorders
Q1: A 6-month-old infant with cystic fibrosis is receiving pancreatic enzyme replacement
therapy. The nurse observes that the mother is mixing the enzyme powder with formula and
feeding it immediately. Which action should the nurse take?
A. Instruct the mother to increase the dose because formula neutralizes the enzyme
B. Tell the mother to mix the powder with hot water to improve dissolution
C. Teach the mother to administer the enzymes 30 minutes before each feeding
D. Advise the mother to crush the enteric-coated beads for better absorption
Correct Answer: C
Rationale: Correct because pancreatic enzymes must be administered 30 minutes before all
meals and snacks to ensure optimal fat and protein absorption in the duodenum. Administering
enzymes with or after meals allows food to pass through the small intestine before adequate
enzyme activity occurs, leading to malabsorption and steatorrhea. Hot water and crushing
enteric-coated beads destroy the protective coating and cause oral mucosal damage, while
increasing the dose does not compensate for incorrect timing.
Q2: A nurse is assessing a newborn and auscultates a harsh, machine-like murmur that is
continuous throughout systole and diastole at the left upper sternal border. The nurse recognizes
this as characteristic of which congenital heart defect?
A. Patent ductus arteriosus
B. Ventricular septal defect
C. Atrial septal defect
D. Tetralogy of Fallot
,Correct Answer: A
Rationale: Correct because a harsh, machine-like murmur that is continuous throughout both
systole and diastole is the hallmark auscultatory finding of patent ductus arteriosus, resulting
from turbulent blood flow through the persistently open ductus between the aorta and pulmonary
artery. Ventricular septal defect produces a harsh holosystolic murmur, atrial septal defect creates
a fixed split S2 with a systolic murmur, and Tetralogy of Fallot presents with a systolic ejection
murmur due to pulmonary stenosis.
Q3: A nurse is conducting a developmental screening on a 2-year-old child. Which findings are
consistent with autism spectrum disorder? Select all that apply.
A. Avoidant or abnormal eye contact
B. Lack of response when called by name
C. Engaging in reciprocal pretend play with peers
D. Repetitive hand-flapping movements
E. Severe aversion to loud noises
Correct Answer: A, B, D, E
Rationale: Correct because autism spectrum disorder is characterized by persistent deficits in
social communication and interaction, including avoidant eye contact, failure to respond to one's
own name, and restricted repetitive behaviors such as hand-flapping and sensory hyperreactivity
to auditory stimuli. Engaging in reciprocal pretend play with peers represents typical social
development and is not consistent with ASD, which features decreased social reciprocity and a
preference for solitary play. Early identification of these hallmark signs allows for referral to
early intervention services, which significantly improve long-term developmental outcomes.
Q4: A 7-year-old child with sickle cell anemia is admitted with severe joint pain in both knees.
The child rates the pain as 8 out of 10. Which intervention should the nurse implement first?
A. Apply ice packs to both knees to reduce inflammation
B. Encourage the child to ambulate to prevent joint stiffness
C. Administer oral acetaminophen and reassess in 2 hours
D. Administer scheduled opioid analgesics and initiate aggressive IV hydration
Correct Answer: D
Rationale: Correct because the priority nursing interventions for a vaso-occlusive sickle cell
crisis include aggressive pain management with scheduled opioid analgesics and vigorous IV
hydration to reduce blood viscosity and promote perfusion to ischemic tissues. Ice application
causes vasoconstriction and worsens vaso-occlusion, while acetaminophen lacks the potency
, required for severe crisis pain. Early mobilization is inappropriate during acute pain and may
increase metabolic demands and tissue hypoxia.
Q5: A 3-year-old child with severe asthma is brought to the emergency department with audible
wheezing, intercostal retractions, and an SpO₂ of 89%. Which assessment finding indicates the
child is deteriorating and requires immediate intervention?
A. Decreased respiratory rate from 40 to 28 breaths per minute
B. Absence of wheezing with decreased breath sounds bilaterally
C. Improved color from cyanotic to pink
D. Decreased heart rate from 160 to 140 bpm
Correct Answer: B
Rationale: Correct because the sudden absence of wheezing accompanied by decreased breath
sounds bilaterally indicates severe airway obstruction and impending respiratory failure due to
insufficient air movement to produce sound. This silent chest finding is a medical emergency
requiring immediate preparation for intubation and mechanical ventilation. A decreased
respiratory rate in a distressed child may represent fatigue rather than improvement, and while
color improvement is positive, the loss of audible breath sounds signals critical decompensation.
Q6: A newborn with transposition of the great arteries is receiving continuous IV prostaglandin
E1. The parents ask why this medication is necessary. Which explanation by the nurse is most
accurate?
A. "It reduces pulmonary vascular resistance to improve blood flow."
B. "It strengthens the heart muscle until surgery can be performed."
C. "It keeps the ductus arteriosus open to allow mixing of oxygenated and unoxygenated blood."
D. "It prevents infection until the arterial switch operation is scheduled."
Correct Answer: C
Rationale: Correct because prostaglandin E1 maintains patency of the ductus arteriosus, which
is essential for survival in transposition of the great arteries by allowing mixing between the
parallel pulmonary and systemic circulations. Without PGE1, the ductus would close, resulting in
two separate non-communicating circuits and rapid deterioration. The medication does not
reduce pulmonary vascular resistance, strengthen myocardium, or provide antimicrobial
prophylaxis.
Q7: Order: Pancrelipase 500 units/kg per meal. The child weighs 16 kg. How many units of
pancrelipase should the nurse administer per meal? ______ units
