NUR 257 EXAM 4: PEDIATRICS AND
OBSTETRICS COMPREHENSIVE
QUESTIONS AND ANSWERS
1. A 2-year-old child is admitted to the pediatric unit with suspected pyloric stenosis. Which
clinical manifestation should the nurse prioritize during assessment?
A. Currant jelly-like stools
B. Right lower quadrant pain with rebound tenderness
C. Ribbon-like, foul-smelling stools
D. Projectile vomiting after feedings
Answer: D
Conceptual Explanation: Projectile vomiting is the hallmark sign of hypertrophic pyloric
stenosis due to the obstruction of the gastric outlet. Currant jelly stools are associated with
intussusception, while ribbon-like stools indicate Hirschsprung’s disease.
2. A nurse is caring for a client at 34 weeks gestation receiving Magnesium Sulfate for
preeclampsia. Which assessment finding requires immediate notification of the provider?
A. Serum magnesium level of 6 mg/dL
,B. Deep tendon reflexes of 2+
C. Urinary output of 40 mL per hour
D. Respiratory rate of 10 breaths per minute
Answer: D
Conceptual Explanation: Magnesium toxicity manifests as respiratory depression (less
than 12/min), loss of deep tendon reflexes, and oliguria. A respiratory rate of 10 is
dangerously low.
3. A 4-year-old is diagnosed with Tetralogy of Fallot and experiences a ‘tet spell’ during a
blood draw. What is the nurse’s immediate action?
A. Administer 100% oxygen via non-rebreather mask
B. Administer IV morphine sulfate
C. Prepare for immediate endotracheal intubation
D. Place the child in the knee-chest position
Answer: D
Conceptual Explanation: The knee-chest position increases systemic vascular resistance,
which decreases the right-to-left shunt and improves oxygenation during a hypercyanotic
spell.
, 4. Which dietary instruction should the nurse provide to the parents of a child newly
diagnosed with Celiac disease?
A. Strictly eliminate wheat, rye, barley, and oats
B. Avoid all dairy products including milk and cheese
C. Increase intake of whole-grain breads to boost fiber
D. Limit intake of fatty foods and simple sugars
Answer: A
Conceptual Explanation: Celiac disease is an immune reaction to eating gluten, a protein
found in wheat, barley, rye, and frequently oats due to cross-contamination.
5. A client at 32 weeks gestation presents with painless, bright red vaginal bleeding. Which
procedure is contraindicated for this client?
A. External fetal monitoring
B. Abdominal ultrasound
C. Venous blood draw for H&H
D. Digital vaginal examination
Answer: D
Conceptual Explanation: Painless bright red bleeding suggests placenta previa. A digital
vaginal exam can stimulate the placenta and cause life-threatening hemorrhage.
OBSTETRICS COMPREHENSIVE
QUESTIONS AND ANSWERS
1. A 2-year-old child is admitted to the pediatric unit with suspected pyloric stenosis. Which
clinical manifestation should the nurse prioritize during assessment?
A. Currant jelly-like stools
B. Right lower quadrant pain with rebound tenderness
C. Ribbon-like, foul-smelling stools
D. Projectile vomiting after feedings
Answer: D
Conceptual Explanation: Projectile vomiting is the hallmark sign of hypertrophic pyloric
stenosis due to the obstruction of the gastric outlet. Currant jelly stools are associated with
intussusception, while ribbon-like stools indicate Hirschsprung’s disease.
2. A nurse is caring for a client at 34 weeks gestation receiving Magnesium Sulfate for
preeclampsia. Which assessment finding requires immediate notification of the provider?
A. Serum magnesium level of 6 mg/dL
,B. Deep tendon reflexes of 2+
C. Urinary output of 40 mL per hour
D. Respiratory rate of 10 breaths per minute
Answer: D
Conceptual Explanation: Magnesium toxicity manifests as respiratory depression (less
than 12/min), loss of deep tendon reflexes, and oliguria. A respiratory rate of 10 is
dangerously low.
3. A 4-year-old is diagnosed with Tetralogy of Fallot and experiences a ‘tet spell’ during a
blood draw. What is the nurse’s immediate action?
A. Administer 100% oxygen via non-rebreather mask
B. Administer IV morphine sulfate
C. Prepare for immediate endotracheal intubation
D. Place the child in the knee-chest position
Answer: D
Conceptual Explanation: The knee-chest position increases systemic vascular resistance,
which decreases the right-to-left shunt and improves oxygenation during a hypercyanotic
spell.
, 4. Which dietary instruction should the nurse provide to the parents of a child newly
diagnosed with Celiac disease?
A. Strictly eliminate wheat, rye, barley, and oats
B. Avoid all dairy products including milk and cheese
C. Increase intake of whole-grain breads to boost fiber
D. Limit intake of fatty foods and simple sugars
Answer: A
Conceptual Explanation: Celiac disease is an immune reaction to eating gluten, a protein
found in wheat, barley, rye, and frequently oats due to cross-contamination.
5. A client at 32 weeks gestation presents with painless, bright red vaginal bleeding. Which
procedure is contraindicated for this client?
A. External fetal monitoring
B. Abdominal ultrasound
C. Venous blood draw for H&H
D. Digital vaginal examination
Answer: D
Conceptual Explanation: Painless bright red bleeding suggests placenta previa. A digital
vaginal exam can stimulate the placenta and cause life-threatening hemorrhage.
