NUR 203 /NUR203 Exam 3 Pediatric Nursing
2026/2027/2028 Testing Cycle | Newly Released
50 Questions With Answers & Expert Rationales
Guaranteed Pass | Graded A+ | Fortis College
Endocrine, Gastrointestinal, & Renal Alterations
Q1: A 7-year-old is admitted with excessive thirst, urinating 8 to 10 times per night, and a 3-
pound weight loss over one week. Laboratory studies reveal serum osmolality of 305 mOsm/kg
and urine specific gravity of 1.002. Which finding confirms diabetes insipidus?
A. Dilutional hyponatremia and peripheral edema
B. Low urine specific gravity with high serum osmolality
C. Concentrated urine with low serum osmolality
D. Weight gain and hypertension
Correct Answer: B
Rationale: Correct because diabetes insipidus is characterized by deficient antidiuretic hormone
or renal resistance to ADH, resulting in the inability to concentrate urine despite concentrated
blood, which manifests as low urine specific gravity below 1.005 and elevated serum osmolality
above 300 mOsm/kg. The massive polyuria and polydipsia lead to dehydration and weight loss
rather than fluid retention. Dilutional hyponatremia, weight gain, and concentrated urine are
hallmark findings of syndrome of inappropriate antidiuretic hormone, not diabetes insipidus.
Q2: A 9-year-old developed a documented Group A beta-hemolytic streptococcal throat infection
three weeks ago and now presents with cola-colored urine and periorbital edema. Which
condition should the nurse suspect?
A. Nephrotic syndrome
B. Urinary tract infection
C. Acute glomerulonephritis
D. Hypopituitarism
Correct Answer: C
Rationale: Correct because acute glomerulonephritis classically presents one to three weeks
,following a streptococcal infection due to immune complex deposition in the glomeruli,
producing the triad of gross hematuria, periorbital edema, and hypertension. Nephrotic syndrome
presents with massive proteinuria and frothy urine rather than hematuria, urinary tract infection
causes dysuria and bacteriuria without the characteristic post-streptococcal timeline, and
hypopituitarism does not produce renal manifestations. The nurse must monitor blood pressure
and urine output closely during the acute phase.
Q3: A 4-week-old infant is brought to the emergency department with non-bilious projectile
vomiting after every feeding. The infant appears hungry and eager to nurse immediately after
vomiting. Which acid-base imbalance should the nurse anticipate?
A. Hypochloremic metabolic alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Respiratory alkalosis
Correct Answer: A
Rationale: Correct because hypertrophic pyloric stenosis causes projectile vomiting of stomach
acid, leading to loss of hydrogen and chloride ions, which produces a hypochloremic metabolic
alkalosis with compensatory respiratory acidosis. The infant's eager re-feeding behavior and the
palpable olive-shaped mass in the right upper quadrant support this diagnosis. The nurse must
prioritize correcting this electrolyte imbalance and dehydration with intravenous fluids before
surgical pyloromyotomy.
Q4: An infant returns to the pediatric unit following cleft lip repair. Which position should the
nurse maintain to protect the operative site?
A. Prone with head turned to the side
B. Supine flat
C. Trendelenburg
D. Upright or side-lying
Correct Answer: D
Rationale: Correct because placing the infant in an upright or side-lying position after cleft lip
repair prevents pressure on the suture line and reduces the risk of bleeding and wound
dehiscence. The prone position is absolutely contraindicated because it places direct pressure on
the surgical site and can compromise the repair. Trendelenburg and supine flat positions do not
protect the suture line and may increase edema or bleeding.
, Q5: A school-age child is diagnosed with central diabetes insipidus. Which clinical findings
should the nurse expect? Select all that apply.
A. Polyuria
B. Polydipsia
C. Weight gain
D. Low urine specific gravity
E. Dilutional hyponatremia
Correct Answer: A, B, D
Rationale: Correct because central diabetes insipidus produces massive polyuria and intense
polydipsia due to ADH deficiency, resulting in dilute urine with low specific gravity below
1.005. Weight gain and dilutional hyponatremia are inconsistent with diabetes insipidus and
instead characterize syndrome of inappropriate antidiuretic hormone, in which fluid retention
dilutes serum sodium. The nurse must monitor daily weights, intake and output, and urine
specific gravity to guide desmopressin therapy.
Q6: A 3-week-old infant is noted to have progressive jaundice, dark tea-colored urine, and clay-
colored stools. Which condition is most likely?
A. Physiologic jaundice
B. Breast milk jaundice
C. Biliary atresia
D. Hemolytic disease of the newborn
Correct Answer: C
Rationale: Correct because biliary atresia presents with progressive conjugated
hyperbilirubinemia after the neonatal period, producing the pathognomonic findings of acholic
clay-colored stools and dark tea-colored urine due to conjugated bilirubin excretion. Physiologic
jaundice resolves within the first one to two weeks of life, breast milk jaundice presents with
unconjugated bilirubin and normal stool color, and hemolytic disease causes unconjugated
hyperbilirubinemia without acholic stools. Urgent evaluation and Kasai procedure before 60 days
of age are essential to preserve liver function.
Q7: A 5-year-old is admitted with nephrotic syndrome. Which finding differentiates this
condition from acute glomerulonephritis?
A. Severe hypertension
B. Massive proteinuria and hypoalbuminemia
C. Gross hematuria
D. Periorbital edema only
2026/2027/2028 Testing Cycle | Newly Released
50 Questions With Answers & Expert Rationales
Guaranteed Pass | Graded A+ | Fortis College
Endocrine, Gastrointestinal, & Renal Alterations
Q1: A 7-year-old is admitted with excessive thirst, urinating 8 to 10 times per night, and a 3-
pound weight loss over one week. Laboratory studies reveal serum osmolality of 305 mOsm/kg
and urine specific gravity of 1.002. Which finding confirms diabetes insipidus?
A. Dilutional hyponatremia and peripheral edema
B. Low urine specific gravity with high serum osmolality
C. Concentrated urine with low serum osmolality
D. Weight gain and hypertension
Correct Answer: B
Rationale: Correct because diabetes insipidus is characterized by deficient antidiuretic hormone
or renal resistance to ADH, resulting in the inability to concentrate urine despite concentrated
blood, which manifests as low urine specific gravity below 1.005 and elevated serum osmolality
above 300 mOsm/kg. The massive polyuria and polydipsia lead to dehydration and weight loss
rather than fluid retention. Dilutional hyponatremia, weight gain, and concentrated urine are
hallmark findings of syndrome of inappropriate antidiuretic hormone, not diabetes insipidus.
Q2: A 9-year-old developed a documented Group A beta-hemolytic streptococcal throat infection
three weeks ago and now presents with cola-colored urine and periorbital edema. Which
condition should the nurse suspect?
A. Nephrotic syndrome
B. Urinary tract infection
C. Acute glomerulonephritis
D. Hypopituitarism
Correct Answer: C
Rationale: Correct because acute glomerulonephritis classically presents one to three weeks
,following a streptococcal infection due to immune complex deposition in the glomeruli,
producing the triad of gross hematuria, periorbital edema, and hypertension. Nephrotic syndrome
presents with massive proteinuria and frothy urine rather than hematuria, urinary tract infection
causes dysuria and bacteriuria without the characteristic post-streptococcal timeline, and
hypopituitarism does not produce renal manifestations. The nurse must monitor blood pressure
and urine output closely during the acute phase.
Q3: A 4-week-old infant is brought to the emergency department with non-bilious projectile
vomiting after every feeding. The infant appears hungry and eager to nurse immediately after
vomiting. Which acid-base imbalance should the nurse anticipate?
A. Hypochloremic metabolic alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Respiratory alkalosis
Correct Answer: A
Rationale: Correct because hypertrophic pyloric stenosis causes projectile vomiting of stomach
acid, leading to loss of hydrogen and chloride ions, which produces a hypochloremic metabolic
alkalosis with compensatory respiratory acidosis. The infant's eager re-feeding behavior and the
palpable olive-shaped mass in the right upper quadrant support this diagnosis. The nurse must
prioritize correcting this electrolyte imbalance and dehydration with intravenous fluids before
surgical pyloromyotomy.
Q4: An infant returns to the pediatric unit following cleft lip repair. Which position should the
nurse maintain to protect the operative site?
A. Prone with head turned to the side
B. Supine flat
C. Trendelenburg
D. Upright or side-lying
Correct Answer: D
Rationale: Correct because placing the infant in an upright or side-lying position after cleft lip
repair prevents pressure on the suture line and reduces the risk of bleeding and wound
dehiscence. The prone position is absolutely contraindicated because it places direct pressure on
the surgical site and can compromise the repair. Trendelenburg and supine flat positions do not
protect the suture line and may increase edema or bleeding.
, Q5: A school-age child is diagnosed with central diabetes insipidus. Which clinical findings
should the nurse expect? Select all that apply.
A. Polyuria
B. Polydipsia
C. Weight gain
D. Low urine specific gravity
E. Dilutional hyponatremia
Correct Answer: A, B, D
Rationale: Correct because central diabetes insipidus produces massive polyuria and intense
polydipsia due to ADH deficiency, resulting in dilute urine with low specific gravity below
1.005. Weight gain and dilutional hyponatremia are inconsistent with diabetes insipidus and
instead characterize syndrome of inappropriate antidiuretic hormone, in which fluid retention
dilutes serum sodium. The nurse must monitor daily weights, intake and output, and urine
specific gravity to guide desmopressin therapy.
Q6: A 3-week-old infant is noted to have progressive jaundice, dark tea-colored urine, and clay-
colored stools. Which condition is most likely?
A. Physiologic jaundice
B. Breast milk jaundice
C. Biliary atresia
D. Hemolytic disease of the newborn
Correct Answer: C
Rationale: Correct because biliary atresia presents with progressive conjugated
hyperbilirubinemia after the neonatal period, producing the pathognomonic findings of acholic
clay-colored stools and dark tea-colored urine due to conjugated bilirubin excretion. Physiologic
jaundice resolves within the first one to two weeks of life, breast milk jaundice presents with
unconjugated bilirubin and normal stool color, and hemolytic disease causes unconjugated
hyperbilirubinemia without acholic stools. Urgent evaluation and Kasai procedure before 60 days
of age are essential to preserve liver function.
Q7: A 5-year-old is admitted with nephrotic syndrome. Which finding differentiates this
condition from acute glomerulonephritis?
A. Severe hypertension
B. Massive proteinuria and hypoalbuminemia
C. Gross hematuria
D. Periorbital edema only
