, Question 1
Which principle best explains why a child with an uncorrected ventricular
septal defect is at risk for developing Eisenmenger syndrome?
A. Right-to-left shunting causes decreased pulmonary blood flow and
cyanosis.
B. Left-to-right shunting leads to pulmonary vascular remodeling and
increased pulmonary vascular resistance.
C. Obstruction to left ventricular outflow results in decreased systemic
perfusion.
D. Right ventricular hypertrophy decreases compliance and impairs
diastolic filling.
Correct Answer: B - Left-to-right shunting leads to pulmonary
vascular remodeling and increased pulmonary vascular
resistance.
RATIONALE
Eisenmenger syndrome occurs when a left-to-right shunt (e.g., VSD)
causes chronic pulmonary overcirculation, leading to pulmonary
vascular remodeling and increased PVR; eventually shunt reverses to
right-to-left. Option A describes a right-to-left shunt at baseline, not
the initial pathophysiology. Options C and D describe other cardiac
lesions (e.g., aortic stenosis, right heart failure) not the primary
mechanism of Eisenmenger.
Question 2
A toddler with acute gastroenteritis is assessed for dehydration. Which set of
findings most strongly indicates moderate dehydration requiring IV fluid
resuscitation rather than oral rehydration?
A. Sunken eyes, delayed capillary refill, and decreased skin turgor
B. Dry mucous membranes, tachycardia, and decreased urine output
C. Lethargy, hypotension, and weak pulses
D. Irritability, thirst, and slightly sunken fontanel
Page 2
, Correct Answer: A - Sunken eyes, delayed capillary refill, and
decreased skin turgor
RATIONALE
Moderate dehydration (5-10% weight loss) is characterized by sunken
eyes, delayed capillary refill (>2 sec), and decreased skin turgor; IV
fluids are often indicated if oral rehydration fails. Option B describes
mild dehydration. Option C indicates severe dehydration with shock.
Option D describes mild dehydration in an infant.
Question 3
A child with nephrotic syndrome is started on prednisone. Which nursing
intervention is most important to include in the plan of care?
A. Monitor blood glucose and blood pressure for corticosteroid side
effects.
B. Restrict fluid intake to prevent edema.
C. Administer live vaccines to prevent infection.
D. Encourage a high-protein diet to replace urinary losses.
Correct Answer: A - Monitor blood glucose and blood pressure
for corticosteroid side effects.
RATIONALE
Corticosteroids can cause hyperglycemia and hypertension;
monitoring is essential. Fluid restriction is not routine unless severe
edema. Live vaccines are contraindicated during immunosuppression.
High-protein diets are not recommended due to increased glomerular
filtration and potential worsening of proteinuria.
Question 4
Which assessment finding in a neonate with a suspected tracheoesophageal
fistula (TEF) is most indicative of the condition?
A. Excessive frothy secretions and coughing during feedings
Page 3
Which principle best explains why a child with an uncorrected ventricular
septal defect is at risk for developing Eisenmenger syndrome?
A. Right-to-left shunting causes decreased pulmonary blood flow and
cyanosis.
B. Left-to-right shunting leads to pulmonary vascular remodeling and
increased pulmonary vascular resistance.
C. Obstruction to left ventricular outflow results in decreased systemic
perfusion.
D. Right ventricular hypertrophy decreases compliance and impairs
diastolic filling.
Correct Answer: B - Left-to-right shunting leads to pulmonary
vascular remodeling and increased pulmonary vascular
resistance.
RATIONALE
Eisenmenger syndrome occurs when a left-to-right shunt (e.g., VSD)
causes chronic pulmonary overcirculation, leading to pulmonary
vascular remodeling and increased PVR; eventually shunt reverses to
right-to-left. Option A describes a right-to-left shunt at baseline, not
the initial pathophysiology. Options C and D describe other cardiac
lesions (e.g., aortic stenosis, right heart failure) not the primary
mechanism of Eisenmenger.
Question 2
A toddler with acute gastroenteritis is assessed for dehydration. Which set of
findings most strongly indicates moderate dehydration requiring IV fluid
resuscitation rather than oral rehydration?
A. Sunken eyes, delayed capillary refill, and decreased skin turgor
B. Dry mucous membranes, tachycardia, and decreased urine output
C. Lethargy, hypotension, and weak pulses
D. Irritability, thirst, and slightly sunken fontanel
Page 2
, Correct Answer: A - Sunken eyes, delayed capillary refill, and
decreased skin turgor
RATIONALE
Moderate dehydration (5-10% weight loss) is characterized by sunken
eyes, delayed capillary refill (>2 sec), and decreased skin turgor; IV
fluids are often indicated if oral rehydration fails. Option B describes
mild dehydration. Option C indicates severe dehydration with shock.
Option D describes mild dehydration in an infant.
Question 3
A child with nephrotic syndrome is started on prednisone. Which nursing
intervention is most important to include in the plan of care?
A. Monitor blood glucose and blood pressure for corticosteroid side
effects.
B. Restrict fluid intake to prevent edema.
C. Administer live vaccines to prevent infection.
D. Encourage a high-protein diet to replace urinary losses.
Correct Answer: A - Monitor blood glucose and blood pressure
for corticosteroid side effects.
RATIONALE
Corticosteroids can cause hyperglycemia and hypertension;
monitoring is essential. Fluid restriction is not routine unless severe
edema. Live vaccines are contraindicated during immunosuppression.
High-protein diets are not recommended due to increased glomerular
filtration and potential worsening of proteinuria.
Question 4
Which assessment finding in a neonate with a suspected tracheoesophageal
fistula (TEF) is most indicative of the condition?
A. Excessive frothy secretions and coughing during feedings
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