NR328/NR 328 Exam 3 V1 | Pediatric Nursing Q&A
with Rationale | Chamberlain University
1. A nurse is assessing an infant with pyloric stenosis. Which of the following clinical
manifestations should the nurse expect to observe?
A. Projectile vomiting after feedings
B. Currant jelly-like stools
C. Steatorrhea and abdominal distention
D. Bile-stained emesis
Correct Answer: A
Explanation: Projectile vomiting is a hallmark sign of hypertrophic pyloric stenosis due to
the gastric outlet obstruction. This usually occurs shortly after feeding and does not contain
bile because the obstruction is proximal to the ampulla of Vater. The nurse may also
palpate an olive-shaped mass in the right upper quadrant of the abdomen.
2. A 4-year-old child is admitted with a diagnosis of Nephrotic Syndrome. Which of the
following laboratory findings should the nurse anticipate?
A. Hyperalbuminemia
B. Low serum cholesterol
C. Reduced hematocrit
D. Massive proteinuria
,Correct Answer: D
Explanation: Nephrotic syndrome is characterized by increased glomerular permeability
to plasma protein, resulting in massive urinary protein loss. This leads to hypoalbuminemia
as the liver cannot keep up with the loss. Consequently, patients often present with severe
edema and hyperlipidemia as the body compensates for low oncotic pressure.
3. A nurse is caring for a child experiencing a ‘tet spell’ (hypercyanotic spell) associated with
Tetralogy of Fallot. What is the priority nursing action?
A. Start an intravenous line for fluid bolus
B. Administer high-flow oxygen via mask
C. Place the child in a knee-chest position
D. Administer intramuscular morphine
Correct Answer: C
Explanation: Placing the child in the knee-chest position increases systemic vascular
resistance, which helps reduce the right-to-left shunting across the ventricular septal
defect. This action forces more blood into the pulmonary artery to improve oxygenation. It
is the immediate, non-invasive priority intervention during an acute hypercyanotic
episode.
4. Which clinical finding is most characteristic of a child diagnosed with Hirschsprung disease?
A. Persistent non-productive cough
B. Jaundice and hepatomegaly
, C. Lower right quadrant pain
D. Ribbon-like, foul-smelling stools
Correct Answer: D
Explanation: Hirschsprung disease involves an absence of ganglion cells in the distal colon,
leading to a functional obstruction. The stool that manages to pass through the narrowed
segment often appears ribbon-like or pellet-like. This condition is typically diagnosed in
infancy when there is a failure to pass meconium within the first 24 to 48 hours.
5. A school-age child is admitted with Acute Post-Streptococcal Glomerulonephritis (APSGN).
Which assessment finding requires immediate notification of the provider?
A. Tea-colored urine
B. Periorbital edema
C. A positive ASO titer
D. Blood pressure of 150/100 mmHg
Correct Answer: D
Explanation: Hypertension is a significant complication of APSGN and can lead to
hypertensive encephalopathy if not managed. While tea-colored urine and periorbital
edema are expected findings of the disease, a severely elevated blood pressure indicates a
risk for seizures. The nurse must monitor neurological status closely and report
hypertension promptly.
with Rationale | Chamberlain University
1. A nurse is assessing an infant with pyloric stenosis. Which of the following clinical
manifestations should the nurse expect to observe?
A. Projectile vomiting after feedings
B. Currant jelly-like stools
C. Steatorrhea and abdominal distention
D. Bile-stained emesis
Correct Answer: A
Explanation: Projectile vomiting is a hallmark sign of hypertrophic pyloric stenosis due to
the gastric outlet obstruction. This usually occurs shortly after feeding and does not contain
bile because the obstruction is proximal to the ampulla of Vater. The nurse may also
palpate an olive-shaped mass in the right upper quadrant of the abdomen.
2. A 4-year-old child is admitted with a diagnosis of Nephrotic Syndrome. Which of the
following laboratory findings should the nurse anticipate?
A. Hyperalbuminemia
B. Low serum cholesterol
C. Reduced hematocrit
D. Massive proteinuria
,Correct Answer: D
Explanation: Nephrotic syndrome is characterized by increased glomerular permeability
to plasma protein, resulting in massive urinary protein loss. This leads to hypoalbuminemia
as the liver cannot keep up with the loss. Consequently, patients often present with severe
edema and hyperlipidemia as the body compensates for low oncotic pressure.
3. A nurse is caring for a child experiencing a ‘tet spell’ (hypercyanotic spell) associated with
Tetralogy of Fallot. What is the priority nursing action?
A. Start an intravenous line for fluid bolus
B. Administer high-flow oxygen via mask
C. Place the child in a knee-chest position
D. Administer intramuscular morphine
Correct Answer: C
Explanation: Placing the child in the knee-chest position increases systemic vascular
resistance, which helps reduce the right-to-left shunting across the ventricular septal
defect. This action forces more blood into the pulmonary artery to improve oxygenation. It
is the immediate, non-invasive priority intervention during an acute hypercyanotic
episode.
4. Which clinical finding is most characteristic of a child diagnosed with Hirschsprung disease?
A. Persistent non-productive cough
B. Jaundice and hepatomegaly
, C. Lower right quadrant pain
D. Ribbon-like, foul-smelling stools
Correct Answer: D
Explanation: Hirschsprung disease involves an absence of ganglion cells in the distal colon,
leading to a functional obstruction. The stool that manages to pass through the narrowed
segment often appears ribbon-like or pellet-like. This condition is typically diagnosed in
infancy when there is a failure to pass meconium within the first 24 to 48 hours.
5. A school-age child is admitted with Acute Post-Streptococcal Glomerulonephritis (APSGN).
Which assessment finding requires immediate notification of the provider?
A. Tea-colored urine
B. Periorbital edema
C. A positive ASO titer
D. Blood pressure of 150/100 mmHg
Correct Answer: D
Explanation: Hypertension is a significant complication of APSGN and can lead to
hypertensive encephalopathy if not managed. While tea-colored urine and periorbital
edema are expected findings of the disease, a severely elevated blood pressure indicates a
risk for seizures. The nurse must monitor neurological status closely and report
hypertension promptly.
