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 nurse is caring for a school-age child with cystic fibrosis. The provider orders pancreatic
enzyme replacement therapy. When should the nurse administer the pancreatic enzymes?
A. Immediately after meals and snacks
B. 30 minutes before all meals and snacks
C. At bedtime with a high-fat snack
D. Only with breakfast and dinner
Correct Answer: B
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. This timing
allows the enzymes to mix with gastric contents and reach the intestinal tract concurrently with
food. Administering enzymes after meals or at incorrect times results in malabsorption,
steatorrhea, and poor weight gain.
Q2: A nurse is caring for an infant with a congenital heart defect. The infant has visible cyanosis,
low SpO₂, and clubbing of the fingers. Which type of defect does the nurse suspect?
A. Patent ductus arteriosus
B. Ventricular septal defect
C. Cyanotic defect with right-to-left shunt
D. Atrial septal defect
,Correct Answer: C
Rationale: Correct because cyanosis, low oxygen saturation, and digital clubbing are hallmark
findings of cyanotic congenital heart defects characterized by right-to-left shunting of
deoxygenated blood into systemic circulation. Acyanotic defects such as patent ductus arteriosus,
ventricular septal defect, and atrial septal defect involve left-to-right shunts that cause pulmonary
congestion without systemic cyanosis. The nurse recognizes these clinical indicators to
differentiate between defect classifications and prioritize appropriate interventions.
Q3: A child with sickle cell anemia is admitted in vaso-occlusive crisis with severe joint pain
rated 8/10. What is the nurse's priority intervention?
A. Administer aggressive IV hydration and scheduled opioid analgesics
B. Apply cold compresses to affected joints
C. Encourage ambulation to improve circulation
D. Administer aspirin for pain relief
Correct Answer: A
Rationale: Correct because the priority interventions for a vaso-occlusive sickle cell crisis
include aggressive IV hydration to reduce blood viscosity and scheduled opioid analgesics to
manage severe pain effectively. Cold compresses cause vasoconstriction and worsen ischemia,
while aspirin is contraindicated in children due to the risk of Reye syndrome. The nurse
implements these evidence-based interventions to restore tissue perfusion and provide adequate
comfort.
Q4: A nurse is assessing a 2-year-old child during a well-child visit. Which finding is most
suggestive of autism spectrum disorder?
A. The child points to objects to show interest to the parent
B. The child engages in pretend play with a toy telephone
C. The child responds consistently when called by name
D. The child displays repetitive hand-flapping and avoids eye contact
Correct Answer: D
Rationale: Correct because repetitive motor movements such as hand-flapping and avoidant or
abnormal eye contact are classic diagnostic indicators of autism spectrum disorder, reflecting
restricted repetitive behaviors and social communication deficits. Pointing to show interest,
pretend play, and responding to one's name are typical developmental milestones that are often
absent or delayed in children with ASD. The nurse uses these observable behaviors to facilitate
early referral for comprehensive developmental evaluation.
, Q5: A nurse is preparing to perform airway clearance therapy for a child with cystic fibrosis.
Which actions by the nurse are appropriate? Select all that apply.
A. Administer bronchodilators prior to therapy
B. Perform therapy before meals or at least 1–2 hours after meals
C. Perform therapy immediately after a large meal
D. Administer hypertonic saline nebulizers before chest physiotherapy
E. Place the child in supine position without postural drainage
Correct Answer: A, B, D
Rationale: Correct because bronchodilators should be administered prior to airway clearance
therapy to open airways and enhance mucus mobilization, and therapy should be performed
before meals or at least 1–2 hours after meals to prevent vomiting and aspiration. Hypertonic
saline nebulizers are administered before chest physiotherapy to loosen thick secretions and
improve clearance efficacy. Performing therapy immediately after a large meal increases
aspiration risk, and supine positioning without postural drainage fails to utilize gravity-dependent
drainage of affected lung segments.
Q6: An infant with tetralogy of Fallot suddenly becomes cyanotic during crying. Which
intervention should the nurse implement first?
A. Administer IV fluids rapidly
B. Prepare the infant for immediate intubation
C. Place the infant in the knee-chest position
D. Begin chest compressions
Correct Answer: C
Rationale: Correct because placing the infant in the knee-chest position is the immediate priority
intervention during a hypercyanotic tet spell, as it increases systemic vascular resistance and
decreases right-to-left shunting through the ventricular septal defect. This positioning reduces the
amount of deoxygenated blood entering the systemic circulation and improves pulmonary blood
flow. The nurse maintains a calm environment while preparing to administer oxygen and
morphine as subsequent interventions.
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 nurse is caring for a school-age child with cystic fibrosis. The provider orders pancreatic
enzyme replacement therapy. When should the nurse administer the pancreatic enzymes?
A. Immediately after meals and snacks
B. 30 minutes before all meals and snacks
C. At bedtime with a high-fat snack
D. Only with breakfast and dinner
Correct Answer: B
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. This timing
allows the enzymes to mix with gastric contents and reach the intestinal tract concurrently with
food. Administering enzymes after meals or at incorrect times results in malabsorption,
steatorrhea, and poor weight gain.
Q2: A nurse is caring for an infant with a congenital heart defect. The infant has visible cyanosis,
low SpO₂, and clubbing of the fingers. Which type of defect does the nurse suspect?
A. Patent ductus arteriosus
B. Ventricular septal defect
C. Cyanotic defect with right-to-left shunt
D. Atrial septal defect
,Correct Answer: C
Rationale: Correct because cyanosis, low oxygen saturation, and digital clubbing are hallmark
findings of cyanotic congenital heart defects characterized by right-to-left shunting of
deoxygenated blood into systemic circulation. Acyanotic defects such as patent ductus arteriosus,
ventricular septal defect, and atrial septal defect involve left-to-right shunts that cause pulmonary
congestion without systemic cyanosis. The nurse recognizes these clinical indicators to
differentiate between defect classifications and prioritize appropriate interventions.
Q3: A child with sickle cell anemia is admitted in vaso-occlusive crisis with severe joint pain
rated 8/10. What is the nurse's priority intervention?
A. Administer aggressive IV hydration and scheduled opioid analgesics
B. Apply cold compresses to affected joints
C. Encourage ambulation to improve circulation
D. Administer aspirin for pain relief
Correct Answer: A
Rationale: Correct because the priority interventions for a vaso-occlusive sickle cell crisis
include aggressive IV hydration to reduce blood viscosity and scheduled opioid analgesics to
manage severe pain effectively. Cold compresses cause vasoconstriction and worsen ischemia,
while aspirin is contraindicated in children due to the risk of Reye syndrome. The nurse
implements these evidence-based interventions to restore tissue perfusion and provide adequate
comfort.
Q4: A nurse is assessing a 2-year-old child during a well-child visit. Which finding is most
suggestive of autism spectrum disorder?
A. The child points to objects to show interest to the parent
B. The child engages in pretend play with a toy telephone
C. The child responds consistently when called by name
D. The child displays repetitive hand-flapping and avoids eye contact
Correct Answer: D
Rationale: Correct because repetitive motor movements such as hand-flapping and avoidant or
abnormal eye contact are classic diagnostic indicators of autism spectrum disorder, reflecting
restricted repetitive behaviors and social communication deficits. Pointing to show interest,
pretend play, and responding to one's name are typical developmental milestones that are often
absent or delayed in children with ASD. The nurse uses these observable behaviors to facilitate
early referral for comprehensive developmental evaluation.
, Q5: A nurse is preparing to perform airway clearance therapy for a child with cystic fibrosis.
Which actions by the nurse are appropriate? Select all that apply.
A. Administer bronchodilators prior to therapy
B. Perform therapy before meals or at least 1–2 hours after meals
C. Perform therapy immediately after a large meal
D. Administer hypertonic saline nebulizers before chest physiotherapy
E. Place the child in supine position without postural drainage
Correct Answer: A, B, D
Rationale: Correct because bronchodilators should be administered prior to airway clearance
therapy to open airways and enhance mucus mobilization, and therapy should be performed
before meals or at least 1–2 hours after meals to prevent vomiting and aspiration. Hypertonic
saline nebulizers are administered before chest physiotherapy to loosen thick secretions and
improve clearance efficacy. Performing therapy immediately after a large meal increases
aspiration risk, and supine positioning without postural drainage fails to utilize gravity-dependent
drainage of affected lung segments.
Q6: An infant with tetralogy of Fallot suddenly becomes cyanotic during crying. Which
intervention should the nurse implement first?
A. Administer IV fluids rapidly
B. Prepare the infant for immediate intubation
C. Place the infant in the knee-chest position
D. Begin chest compressions
Correct Answer: C
Rationale: Correct because placing the infant in the knee-chest position is the immediate priority
intervention during a hypercyanotic tet spell, as it increases systemic vascular resistance and
decreases right-to-left shunting through the ventricular septal defect. This positioning reduces the
amount of deoxygenated blood entering the systemic circulation and improves pulmonary blood
flow. The nurse maintains a calm environment while preparing to administer oxygen and
morphine as subsequent interventions.
