, Question 1
A pediatric client with severe acute malnutrition is started on refeeding. Which
electrolyte abnormality is most characteristic of refeeding syndrome and
requires immediate correction?
A. Hypernatremia
B. Hypophosphatemia
C. Hyperkalemia
D. Hypercalcemia
Correct Answer: B - Hypophosphatemia
RATIONALE
Refeeding syndrome is marked by hypophosphatemia due to
intracellular shift of phosphate during reintroduction of carbohydrates,
leading to ATP depletion. Hypernatremia, hyperkalemia, and
hypercalcemia are not typical; hypokalemia and hypomagnesemia
may also occur but hypophosphatemia is the hallmark.
Question 2
Which assessment finding best differentiates nephrotic syndrome from acute
glomerulonephritis in a pediatric client?
A. Hematuria with red blood cell casts
B. Hypertension and oliguria
C. Massive proteinuria and hypoalbuminemia
D. Elevated antistreptolysin O titer
Correct Answer: C - Massive proteinuria and hypoalbuminemia
RATIONALE
Nephrotic syndrome is characterized by massive proteinuria (>3.5
g/day), hypoalbuminemia, edema, and hyperlipidemia. Hematuria
with RBC casts, hypertension, and elevated ASO titer are more typical
of acute glomerulonephritis, which primarily involves inflammation
rather than selective protein loss.
Page 2
, Question 3
A child with a ventricular septal defect (VSD) is at risk for which complication
due to turbulent blood flow?
A. Infective endocarditis
B. Polycythemia
C. Systemic hypertension
D. Pulmonary stenosis
Correct Answer: A - Infective endocarditis
RATIONALE
Turbulent blood flow across a VSD damages endocardial surfaces,
increasing risk for infective endocarditis. Polycythemia occurs in
cyanotic defects, systemic hypertension is not directly linked, and
pulmonary stenosis is a separate defect, not a complication of VSD.
Question 4
Which developmental milestone is most indicative of a 9-month-old infant's
fine motor progression?
A. Transferring objects hand to hand
B. Building a tower of two cubes
C. Scribbling with a crayon
D. Using a pincer grasp
Correct Answer: D - Using a pincer grasp
RATIONALE
A pincer grasp (thumb and forefinger) typically emerges around 9
months and signifies fine motor maturation. Transferring objects hand
to hand is seen around 6-7 months, building a tower of two cubes at 15
months, and scribbling at 12-15 months.
Page 3
, Question 5
A pediatric client with cystic fibrosis is prescribed a high-calorie, high-fat diet.
Which pancreatic enzyme replacement regimen is most appropriate?
A. Administer enzymes once daily with breakfast
B. Give enzymes 30 minutes before each meal
C. Give enzymes with each meal and snack
D. Administer enzymes only when symptoms occur
Correct Answer: C - Give enzymes with each meal and snack
RATIONALE
Pancreatic enzymes must be given with all meals and snacks to
facilitate digestion and absorption of nutrients. Once-daily dosing,
giving 30 minutes before meals, or as-needed dosing are ineffective
because enzymes require presence of food for optimal action.
Question 6
Which parameter is most critical to monitor in a pediatric client receiving
intravenous furosemide for heart failure?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: B - Serum potassium
RATIONALE
Loop diuretics like furosemide cause significant potassium loss,
predisposing to hypokalemia and arrhythmias. While sodium, calcium,
and magnesium can be affected, potassium is the most critical to
monitor due to cardiac risk.
Page 4
A pediatric client with severe acute malnutrition is started on refeeding. Which
electrolyte abnormality is most characteristic of refeeding syndrome and
requires immediate correction?
A. Hypernatremia
B. Hypophosphatemia
C. Hyperkalemia
D. Hypercalcemia
Correct Answer: B - Hypophosphatemia
RATIONALE
Refeeding syndrome is marked by hypophosphatemia due to
intracellular shift of phosphate during reintroduction of carbohydrates,
leading to ATP depletion. Hypernatremia, hyperkalemia, and
hypercalcemia are not typical; hypokalemia and hypomagnesemia
may also occur but hypophosphatemia is the hallmark.
Question 2
Which assessment finding best differentiates nephrotic syndrome from acute
glomerulonephritis in a pediatric client?
A. Hematuria with red blood cell casts
B. Hypertension and oliguria
C. Massive proteinuria and hypoalbuminemia
D. Elevated antistreptolysin O titer
Correct Answer: C - Massive proteinuria and hypoalbuminemia
RATIONALE
Nephrotic syndrome is characterized by massive proteinuria (>3.5
g/day), hypoalbuminemia, edema, and hyperlipidemia. Hematuria
with RBC casts, hypertension, and elevated ASO titer are more typical
of acute glomerulonephritis, which primarily involves inflammation
rather than selective protein loss.
Page 2
, Question 3
A child with a ventricular septal defect (VSD) is at risk for which complication
due to turbulent blood flow?
A. Infective endocarditis
B. Polycythemia
C. Systemic hypertension
D. Pulmonary stenosis
Correct Answer: A - Infective endocarditis
RATIONALE
Turbulent blood flow across a VSD damages endocardial surfaces,
increasing risk for infective endocarditis. Polycythemia occurs in
cyanotic defects, systemic hypertension is not directly linked, and
pulmonary stenosis is a separate defect, not a complication of VSD.
Question 4
Which developmental milestone is most indicative of a 9-month-old infant's
fine motor progression?
A. Transferring objects hand to hand
B. Building a tower of two cubes
C. Scribbling with a crayon
D. Using a pincer grasp
Correct Answer: D - Using a pincer grasp
RATIONALE
A pincer grasp (thumb and forefinger) typically emerges around 9
months and signifies fine motor maturation. Transferring objects hand
to hand is seen around 6-7 months, building a tower of two cubes at 15
months, and scribbling at 12-15 months.
Page 3
, Question 5
A pediatric client with cystic fibrosis is prescribed a high-calorie, high-fat diet.
Which pancreatic enzyme replacement regimen is most appropriate?
A. Administer enzymes once daily with breakfast
B. Give enzymes 30 minutes before each meal
C. Give enzymes with each meal and snack
D. Administer enzymes only when symptoms occur
Correct Answer: C - Give enzymes with each meal and snack
RATIONALE
Pancreatic enzymes must be given with all meals and snacks to
facilitate digestion and absorption of nutrients. Once-daily dosing,
giving 30 minutes before meals, or as-needed dosing are ineffective
because enzymes require presence of food for optimal action.
Question 6
Which parameter is most critical to monitor in a pediatric client receiving
intravenous furosemide for heart failure?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: B - Serum potassium
RATIONALE
Loop diuretics like furosemide cause significant potassium loss,
predisposing to hypokalemia and arrhythmias. While sodium, calcium,
and magnesium can be affected, potassium is the most critical to
monitor due to cardiac risk.
Page 4
