Galen College of Nursing | NU 170 Maternal-Child Nursing — Exam 2
NU 170: Maternal-Child Nursing — Exam 2 Paper.
Student Name: ___________________________ Date: ________________________
Student ID: _____________________________ Score: ________ /
Question 1. A pediatric nurse is caring for an 8-month-old infant admitted with severe gastroenteritis
caused by Rotavirus. Which clinical manifestation should the nurse prioritize monitoring to evaluate for
metabolic acidosis?
A) Persistent projectile vomiting leading to loss of gastric acid
B) Severe diarrhea resulting in loss of alkaline intestinal secretions
C) Excessive drooling and thick frothy mucus in the pharynx
D) Steatorrhea with foul-smelling, bulky, fatty stools
Correct Answer: Option B ✔
Rationale: In pediatric patients with gastroenteritis, severe diarrhea leads to significant loss of base
(bicarbonate) in the stool, resulting in metabolic acidosis. Conversely, severe vomiting leads to loss of gastric
hydrochloric acid, predisposing the child to metabolic alkalosis. Rotavirus is a primary causative agent in
children aged 3 to 24 months.
Question 2. A infant with cleft lip and cleft palate is scheduled for surgical repair. Which intervention
should the nurse implement to facilitate adequate nutrition and minimize aspiration risk prior to
surgery?
A) Position the infant completely supine and administer fluids via a hard plastic straw
B) Place the infant in Trendelenburg position during bottle feedings and feed rapidly
C) Thicken all liquid formulas with rice cereal and feed only using a standard gravity syringe without a
nipple
D) Utilize the ESSR feeding technique (Enlarge nipple, Stimulate suck, Swallow, Rest) while holding the
infant upright
Correct Answer: Option D ✔
Rationale: Preoperative feeding for an infant with cleft lip/palate focuses on preventing aspiration and
ensuring proper intake using the ESSR method (Enlarge nipple, Stimulate sucking reflex, Swallow, Rest) with
the infant held in an upright position. Postoperatively, hard objects like straws, spoons, or hard nipples are
strictly avoided to protect the palate repair.
Page 1
, Galen College of Nursing | NU 170 Maternal-Child Nursing — Exam 2
Question 3. A newborn is suspected of having Esophageal Atresia with Tracheoesophageal Fistula (TEF).
Which triad of clinical manifestations classic for this congenital anomaly should the nurse immediately
observe for during initial feeding?
A) Projectile vomiting, olive-shaped mass, and hunger
B) Coughing, choking, and cyanosis ('3 C's')
C) Ribbon-like stools, failure to pass meconium, and abdominal distention
D) Currant jelly-like stools, sausage-shaped mass, and colicky pain
Correct Answer: Option B ✔
Rationale: The classic clinical triad for Esophageal Atresia and Tracheoesophageal Fistula (TEF) consists of
coughing, choking, and cyanosis with feedings ('3 C's'), accompanied by excessive oral drooling and mucus. TEF
is a surgical emergency requiring immediate NPO status and frequent suctioning to prevent aspiration.
Question 4. The nurse provides discharge instructions to the parents of a 4-month-old infant diagnosed
with Gastroesophageal Reflux (GER). Which home care strategy recommended by the nurse is most
appropriate?
A) Thicken the infant's formula with rice cereal and maintain an upright position after feedings
B) Place the infant in a prone position immediately after feeding to aid gastric emptying
C) Administer high-dose oral corticosteroids 30 minutes prior to every morning meal
D) Provide large volume feedings at extended 8-hour intervals to allow stomach rest
Correct Answer: Option A ✔
Rationale: Conservative management of GER in infants includes small, frequent feedings, thickening formula
with rice cereal as recommended, and keeping the infant upright after feedings to decrease regurgitation.
Prone positioning while awake requires continuous supervision, and large volume feedings exacerbate reflux.
Question 5. A 4-week-old male infant presents with non-bilious projectile vomiting after every feeding.
On physical examination, the nurse palpates a firm, olive-shaped mass in the epigastrium. Which
surgical procedure does the nurse anticipate?
A) Orchiopexy
B) Hydrostatic reduction
C) Pyloromyotomy
D) Pull-through procedure
Correct Answer: Option C ✔
Rationale: Hypertrophic pyloric stenosis is characterized by narrowing of the pyloric sphincter, leading to non-
bilious projectile vomiting and a palpable olive-shaped mass in the epigastrium. The definitive surgical
treatment is a pyloromyotomy.
Page 2
, Galen College of Nursing | NU 170 Maternal-Child Nursing — Exam 2
Question 6. A 2-year-old child is diagnosed with Celiac Disease (gluten-sensitive enteropathy). Which
dietary adjustment must the nurse teach the parents to maintain for the child's lifetime?
A) Complete elimination of dairy products, lactose, and citrus fruits
B) Strict avoidance of wheat, barley, rye, and oats, substituting with corn and rice
C) Restriction of high-protein meats and seafood while encouraging whole wheat bread
D) High-phenylalanine liquid supplements combined with low-fat dairy milk
Correct Answer: Option B ✔
Rationale: Celiac disease is an autoimmune intolerance to gluten, a protein found in wheat, barley, rye, and
oats. Ingestion causes atrophy of intestinal villi and malabsorption (leading to steatorrhea and chronic
diarrhea). Management requires a lifelong strict gluten-free diet, using alternative grains like corn and rice.
Question 7. A newborn has failed to pass meconium within the first 36 hours of life and exhibits
abdominal distention and bilious vomiting. The nurse recognizes these findings as indicative of
Hirschsprung's disease. What is the primary underlying pathophysiology?
A) Absence of parasympathetic ganglion cells in a segment of the colon leading to lack of peristalsis
B) Telescoping of a proximal segment of the intestine into a distal intestinal lumen
C) Incompetence of the lower esophageal sphincter resulting in gastric acid reflux
D) Immune-mediated inflammation of the renal glomeruli following a streptococcal skin infection
Correct Answer: Option A ✔
Rationale: Hirschsprung's disease (congenital aganglionic megacolon) is caused by the absence of ganglion
cells in a segment of the large intestine, preventing normal peristalsis and causing mechanical obstruction. Key
newborn finding is failure to pass meconium within 24–48 hours; older children present with ribbon-like, foul-
smelling stools.
Question 8. A 10-month-old infant is brought to the emergency department with sudden, severe colicky
abdominal pain where the infant screams and draws the knees to the chest. The mother reports a stool
resembling 'currant jelly.' Which intervention is initially indicated?
A) Immediate bilateral nephrectomy and radiation therapy
B) Administration of oral high-dose aspirin and digoxin
C) Hydrostatic reduction using air or fluid enema
D) Application of a Pavlik harness for 8 to 12 weeks
Correct Answer: Option C ✔
Rationale: Intussusception involves telescoping of one bowel segment into another, producing colicky pain,
knees drawn to abdomen, a sausage-shaped mass in the upper right quadrant, and 'currant jelly' stools (blood
and mucus). Non-surgical hydrostatic reduction using air or barium enema is the primary therapeutic
procedure unless perforation is suspected.
Page 3
NU 170: Maternal-Child Nursing — Exam 2 Paper.
Student Name: ___________________________ Date: ________________________
Student ID: _____________________________ Score: ________ /
Question 1. A pediatric nurse is caring for an 8-month-old infant admitted with severe gastroenteritis
caused by Rotavirus. Which clinical manifestation should the nurse prioritize monitoring to evaluate for
metabolic acidosis?
A) Persistent projectile vomiting leading to loss of gastric acid
B) Severe diarrhea resulting in loss of alkaline intestinal secretions
C) Excessive drooling and thick frothy mucus in the pharynx
D) Steatorrhea with foul-smelling, bulky, fatty stools
Correct Answer: Option B ✔
Rationale: In pediatric patients with gastroenteritis, severe diarrhea leads to significant loss of base
(bicarbonate) in the stool, resulting in metabolic acidosis. Conversely, severe vomiting leads to loss of gastric
hydrochloric acid, predisposing the child to metabolic alkalosis. Rotavirus is a primary causative agent in
children aged 3 to 24 months.
Question 2. A infant with cleft lip and cleft palate is scheduled for surgical repair. Which intervention
should the nurse implement to facilitate adequate nutrition and minimize aspiration risk prior to
surgery?
A) Position the infant completely supine and administer fluids via a hard plastic straw
B) Place the infant in Trendelenburg position during bottle feedings and feed rapidly
C) Thicken all liquid formulas with rice cereal and feed only using a standard gravity syringe without a
nipple
D) Utilize the ESSR feeding technique (Enlarge nipple, Stimulate suck, Swallow, Rest) while holding the
infant upright
Correct Answer: Option D ✔
Rationale: Preoperative feeding for an infant with cleft lip/palate focuses on preventing aspiration and
ensuring proper intake using the ESSR method (Enlarge nipple, Stimulate sucking reflex, Swallow, Rest) with
the infant held in an upright position. Postoperatively, hard objects like straws, spoons, or hard nipples are
strictly avoided to protect the palate repair.
Page 1
, Galen College of Nursing | NU 170 Maternal-Child Nursing — Exam 2
Question 3. A newborn is suspected of having Esophageal Atresia with Tracheoesophageal Fistula (TEF).
Which triad of clinical manifestations classic for this congenital anomaly should the nurse immediately
observe for during initial feeding?
A) Projectile vomiting, olive-shaped mass, and hunger
B) Coughing, choking, and cyanosis ('3 C's')
C) Ribbon-like stools, failure to pass meconium, and abdominal distention
D) Currant jelly-like stools, sausage-shaped mass, and colicky pain
Correct Answer: Option B ✔
Rationale: The classic clinical triad for Esophageal Atresia and Tracheoesophageal Fistula (TEF) consists of
coughing, choking, and cyanosis with feedings ('3 C's'), accompanied by excessive oral drooling and mucus. TEF
is a surgical emergency requiring immediate NPO status and frequent suctioning to prevent aspiration.
Question 4. The nurse provides discharge instructions to the parents of a 4-month-old infant diagnosed
with Gastroesophageal Reflux (GER). Which home care strategy recommended by the nurse is most
appropriate?
A) Thicken the infant's formula with rice cereal and maintain an upright position after feedings
B) Place the infant in a prone position immediately after feeding to aid gastric emptying
C) Administer high-dose oral corticosteroids 30 minutes prior to every morning meal
D) Provide large volume feedings at extended 8-hour intervals to allow stomach rest
Correct Answer: Option A ✔
Rationale: Conservative management of GER in infants includes small, frequent feedings, thickening formula
with rice cereal as recommended, and keeping the infant upright after feedings to decrease regurgitation.
Prone positioning while awake requires continuous supervision, and large volume feedings exacerbate reflux.
Question 5. A 4-week-old male infant presents with non-bilious projectile vomiting after every feeding.
On physical examination, the nurse palpates a firm, olive-shaped mass in the epigastrium. Which
surgical procedure does the nurse anticipate?
A) Orchiopexy
B) Hydrostatic reduction
C) Pyloromyotomy
D) Pull-through procedure
Correct Answer: Option C ✔
Rationale: Hypertrophic pyloric stenosis is characterized by narrowing of the pyloric sphincter, leading to non-
bilious projectile vomiting and a palpable olive-shaped mass in the epigastrium. The definitive surgical
treatment is a pyloromyotomy.
Page 2
, Galen College of Nursing | NU 170 Maternal-Child Nursing — Exam 2
Question 6. A 2-year-old child is diagnosed with Celiac Disease (gluten-sensitive enteropathy). Which
dietary adjustment must the nurse teach the parents to maintain for the child's lifetime?
A) Complete elimination of dairy products, lactose, and citrus fruits
B) Strict avoidance of wheat, barley, rye, and oats, substituting with corn and rice
C) Restriction of high-protein meats and seafood while encouraging whole wheat bread
D) High-phenylalanine liquid supplements combined with low-fat dairy milk
Correct Answer: Option B ✔
Rationale: Celiac disease is an autoimmune intolerance to gluten, a protein found in wheat, barley, rye, and
oats. Ingestion causes atrophy of intestinal villi and malabsorption (leading to steatorrhea and chronic
diarrhea). Management requires a lifelong strict gluten-free diet, using alternative grains like corn and rice.
Question 7. A newborn has failed to pass meconium within the first 36 hours of life and exhibits
abdominal distention and bilious vomiting. The nurse recognizes these findings as indicative of
Hirschsprung's disease. What is the primary underlying pathophysiology?
A) Absence of parasympathetic ganglion cells in a segment of the colon leading to lack of peristalsis
B) Telescoping of a proximal segment of the intestine into a distal intestinal lumen
C) Incompetence of the lower esophageal sphincter resulting in gastric acid reflux
D) Immune-mediated inflammation of the renal glomeruli following a streptococcal skin infection
Correct Answer: Option A ✔
Rationale: Hirschsprung's disease (congenital aganglionic megacolon) is caused by the absence of ganglion
cells in a segment of the large intestine, preventing normal peristalsis and causing mechanical obstruction. Key
newborn finding is failure to pass meconium within 24–48 hours; older children present with ribbon-like, foul-
smelling stools.
Question 8. A 10-month-old infant is brought to the emergency department with sudden, severe colicky
abdominal pain where the infant screams and draws the knees to the chest. The mother reports a stool
resembling 'currant jelly.' Which intervention is initially indicated?
A) Immediate bilateral nephrectomy and radiation therapy
B) Administration of oral high-dose aspirin and digoxin
C) Hydrostatic reduction using air or fluid enema
D) Application of a Pavlik harness for 8 to 12 weeks
Correct Answer: Option C ✔
Rationale: Intussusception involves telescoping of one bowel segment into another, producing colicky pain,
knees drawn to abdomen, a sausage-shaped mass in the upper right quadrant, and 'currant jelly' stools (blood
and mucus). Non-surgical hydrostatic reduction using air or barium enema is the primary therapeutic
procedure unless perforation is suspected.
Page 3
