, Question 1
A toddler with severe acute malnutrition and refeeding syndrome is being
advanced on enteral feeds. Which electrolyte abnormality most directly
increases risk for fatal cardiac arrhythmia during refeeding?
A. Hypernatremia
B. Hypophosphatemia
C. Hypercalcemia
D. Hypochloremia
Correct Answer: B - Hypophosphatemia
RATIONALE
Hypophosphatemia is a hallmark of refeeding syndrome and can
precipitate cardiac failure and arrhythmias due to depleted ATP and
impaired myocardial function. Hypernatremia, hypercalcemia, and
hypochloremia are not the primary drivers of refeeding-related
arrhythmias.
Question 2
A child with nephrotic syndrome is started on high-dose prednisone. Which
monitoring parameter best detects early steroid-induced hyperglycemia?
A. Fasting blood glucose
B. Random urine glucose
C. Postprandial blood glucose
D. Hemoglobin A1c
Correct Answer: C - Postprandial blood glucose
RATIONALE
Postprandial glucose is the most sensitive early indicator of
steroid-induced hyperglycemia because steroids primarily increase
insulin resistance after meals. Fasting glucose, urine glucose, and
HbA1c are less sensitive for early detection.
Page 2
, Question 3
Which assessment finding most strongly suggests impending respiratory failure
in a child with status asthmaticus?
A. Audible wheezing
B. Pulsus paradoxus
C. Silent chest
D. Nasal flaring
Correct Answer: C - Silent chest
RATIONALE
A silent chest indicates minimal air movement and is a late, ominous
sign of impending respiratory failure in severe asthma. Wheezing,
pulsus paradoxus, and nasal flaring can occur earlier and do not alone
indicate imminent failure.
Question 4
A neonate with suspected ductal-dependent congenital heart disease is started
on prostaglandin E1. Which adverse effect requires immediate nursing
intervention?
A. Apnea
B. Fever
C. Hypotension
D. Irritability
Correct Answer: A - Apnea
RATIONALE
Apnea is a common and potentially life-threatening adverse effect of
prostaglandin E1, requiring immediate airway support and possible
dose reduction. Fever, hypotension, and irritability may occur but are
less immediately dangerous.
Page 3
, Question 5
A child with acute glomerulonephritis presents with hypertension and oliguria.
Which intervention is most appropriate initially?
A. Administer IV furosemide
B. Restrict protein intake
C. Encourage high fluid intake
D. Apply warm compresses to abdomen
Correct Answer: A - Administer IV furosemide
RATIONALE
IV furosemide reduces fluid overload and hypertension in acute
glomerulonephritis by promoting diuresis. Protein restriction, fluid
loading, and warm compresses are not initial management priorities.
Question 6
An infant with a ventricular septal defect (VSD) is failing to thrive. Which
compensatory mechanism most directly contributes to increased pulmonary
blood flow?
A. Left-to-right shunting
B. Right-to-left shunting
C. Increased pulmonary vascular resistance
D. Decreased systemic vascular resistance
Correct Answer: A - Left-to-right shunting
RATIONALE
A VSD causes left-to-right shunting, leading to increased pulmonary
blood flow and eventual heart failure. Right-to-left shunting, increased
PVR, and decreased SVR do not directly cause the increased
pulmonary flow seen in VSD.
Page 4
A toddler with severe acute malnutrition and refeeding syndrome is being
advanced on enteral feeds. Which electrolyte abnormality most directly
increases risk for fatal cardiac arrhythmia during refeeding?
A. Hypernatremia
B. Hypophosphatemia
C. Hypercalcemia
D. Hypochloremia
Correct Answer: B - Hypophosphatemia
RATIONALE
Hypophosphatemia is a hallmark of refeeding syndrome and can
precipitate cardiac failure and arrhythmias due to depleted ATP and
impaired myocardial function. Hypernatremia, hypercalcemia, and
hypochloremia are not the primary drivers of refeeding-related
arrhythmias.
Question 2
A child with nephrotic syndrome is started on high-dose prednisone. Which
monitoring parameter best detects early steroid-induced hyperglycemia?
A. Fasting blood glucose
B. Random urine glucose
C. Postprandial blood glucose
D. Hemoglobin A1c
Correct Answer: C - Postprandial blood glucose
RATIONALE
Postprandial glucose is the most sensitive early indicator of
steroid-induced hyperglycemia because steroids primarily increase
insulin resistance after meals. Fasting glucose, urine glucose, and
HbA1c are less sensitive for early detection.
Page 2
, Question 3
Which assessment finding most strongly suggests impending respiratory failure
in a child with status asthmaticus?
A. Audible wheezing
B. Pulsus paradoxus
C. Silent chest
D. Nasal flaring
Correct Answer: C - Silent chest
RATIONALE
A silent chest indicates minimal air movement and is a late, ominous
sign of impending respiratory failure in severe asthma. Wheezing,
pulsus paradoxus, and nasal flaring can occur earlier and do not alone
indicate imminent failure.
Question 4
A neonate with suspected ductal-dependent congenital heart disease is started
on prostaglandin E1. Which adverse effect requires immediate nursing
intervention?
A. Apnea
B. Fever
C. Hypotension
D. Irritability
Correct Answer: A - Apnea
RATIONALE
Apnea is a common and potentially life-threatening adverse effect of
prostaglandin E1, requiring immediate airway support and possible
dose reduction. Fever, hypotension, and irritability may occur but are
less immediately dangerous.
Page 3
, Question 5
A child with acute glomerulonephritis presents with hypertension and oliguria.
Which intervention is most appropriate initially?
A. Administer IV furosemide
B. Restrict protein intake
C. Encourage high fluid intake
D. Apply warm compresses to abdomen
Correct Answer: A - Administer IV furosemide
RATIONALE
IV furosemide reduces fluid overload and hypertension in acute
glomerulonephritis by promoting diuresis. Protein restriction, fluid
loading, and warm compresses are not initial management priorities.
Question 6
An infant with a ventricular septal defect (VSD) is failing to thrive. Which
compensatory mechanism most directly contributes to increased pulmonary
blood flow?
A. Left-to-right shunting
B. Right-to-left shunting
C. Increased pulmonary vascular resistance
D. Decreased systemic vascular resistance
Correct Answer: A - Left-to-right shunting
RATIONALE
A VSD causes left-to-right shunting, leading to increased pulmonary
blood flow and eventual heart failure. Right-to-left shunting, increased
PVR, and decreased SVR do not directly cause the increased
pulmonary flow seen in VSD.
Page 4
