NR 328 PEDIATRIC NURSING WEEK 3
COMPREHENSIVE STUDY GUIDE 2026
1. A 3-year-old child is brought to the emergency department with a sudden onset of high
fever, drooling, and a muffled voice. The child is sitting in a tripod position. Which nursing
action is the highest priority?
A. Obtain a throat culture to identify the causative organism.
B. Prepare for immediate endotracheal intubation or tracheostomy.
C. Perform a visual inspection of the throat using a tongue blade.
D. Administer a dose of nebulized epinephrine as ordered.
Answer: B
Conceptual Explanation: These symptoms are classic signs of epiglottitis, a medical
emergency. The priority is to maintain a patent airway. Inspecting the throat with a tongue
blade can trigger a complete airway obstruction.
2. A child with Tetralogy of Fallot (TOF) experiences a hypercyanotic spell (‘Tet spell’). Which
position should the nurse immediately place the child in?
A. Knee-chest position
B. High Fowler’s position
,C. Supine with legs elevated
D. Left lateral recumbent
Answer: A
Conceptual Explanation: The knee-chest position increases systemic vascular resistance,
which helps reduce the right-to-left shunt across the VSD, improving oxygenation to the
lungs during a Tet spell.
3. The nurse is caring for an infant with suspected pyloric stenosis. Which clinical
manifestation is most characteristic of this condition?
A. Currant jelly-like stools
B. Bile-stained emesis
C. Abdominal distention and ribbon-like stools
D. Projectile vomiting after feeding
Answer: D
Conceptual Explanation: Projectile vomiting, which is non-bilious, and an olive-shaped
mass in the epigastrium are hallmark signs of hypertrophic pyloric stenosis.
4. A child with Cystic Fibrosis (CF) is receiving Pancrelipase. The nurse knows the medication
is effective if which of the following is observed?
A. The child has an increase in appetite.
B. The child experiences fewer respiratory infections.
, C. Stools become less frequent and lose their foul odor.
D. Sweat chloride levels return to a normal range.
Answer: C
Conceptual Explanation: Pancreatic enzymes (Pancrelipase) are used to aid digestion of
fats and proteins. Effectiveness is evidenced by a decrease in steatorrhea (fatty, foul-
smelling stools).
5. In a child diagnosed with Coarctation of the Aorta, which assessment finding should the
nurse expect?
A. Strong pedal pulses and weak brachial pulses.
B. Bounding pulses in the upper extremities and weak pulses in the lower extremities.
C. Cyanosis that increases during crying episodes.
D. A continuous machinery-like murmur heard at the left sternal border.
Answer: B
Conceptual Explanation: Coarctation of the aorta is a narrowing that restricts blood flow
to the lower body, resulting in high blood pressure and bounding pulses in the arms, but
low blood pressure and weak pulses in the legs.
6. A 6-year-old is hospitalized with Acute Rheumatic Fever. Which laboratory result most
specifically supports this diagnosis following a recent sore throat?
A. Elevated White Blood Cell (WBC) count
COMPREHENSIVE STUDY GUIDE 2026
1. A 3-year-old child is brought to the emergency department with a sudden onset of high
fever, drooling, and a muffled voice. The child is sitting in a tripod position. Which nursing
action is the highest priority?
A. Obtain a throat culture to identify the causative organism.
B. Prepare for immediate endotracheal intubation or tracheostomy.
C. Perform a visual inspection of the throat using a tongue blade.
D. Administer a dose of nebulized epinephrine as ordered.
Answer: B
Conceptual Explanation: These symptoms are classic signs of epiglottitis, a medical
emergency. The priority is to maintain a patent airway. Inspecting the throat with a tongue
blade can trigger a complete airway obstruction.
2. A child with Tetralogy of Fallot (TOF) experiences a hypercyanotic spell (‘Tet spell’). Which
position should the nurse immediately place the child in?
A. Knee-chest position
B. High Fowler’s position
,C. Supine with legs elevated
D. Left lateral recumbent
Answer: A
Conceptual Explanation: The knee-chest position increases systemic vascular resistance,
which helps reduce the right-to-left shunt across the VSD, improving oxygenation to the
lungs during a Tet spell.
3. The nurse is caring for an infant with suspected pyloric stenosis. Which clinical
manifestation is most characteristic of this condition?
A. Currant jelly-like stools
B. Bile-stained emesis
C. Abdominal distention and ribbon-like stools
D. Projectile vomiting after feeding
Answer: D
Conceptual Explanation: Projectile vomiting, which is non-bilious, and an olive-shaped
mass in the epigastrium are hallmark signs of hypertrophic pyloric stenosis.
4. A child with Cystic Fibrosis (CF) is receiving Pancrelipase. The nurse knows the medication
is effective if which of the following is observed?
A. The child has an increase in appetite.
B. The child experiences fewer respiratory infections.
, C. Stools become less frequent and lose their foul odor.
D. Sweat chloride levels return to a normal range.
Answer: C
Conceptual Explanation: Pancreatic enzymes (Pancrelipase) are used to aid digestion of
fats and proteins. Effectiveness is evidenced by a decrease in steatorrhea (fatty, foul-
smelling stools).
5. In a child diagnosed with Coarctation of the Aorta, which assessment finding should the
nurse expect?
A. Strong pedal pulses and weak brachial pulses.
B. Bounding pulses in the upper extremities and weak pulses in the lower extremities.
C. Cyanosis that increases during crying episodes.
D. A continuous machinery-like murmur heard at the left sternal border.
Answer: B
Conceptual Explanation: Coarctation of the aorta is a narrowing that restricts blood flow
to the lower body, resulting in high blood pressure and bounding pulses in the arms, but
low blood pressure and weak pulses in the legs.
6. A 6-year-old is hospitalized with Acute Rheumatic Fever. Which laboratory result most
specifically supports this diagnosis following a recent sore throat?
A. Elevated White Blood Cell (WBC) count
