, Question 1
Which pathophysiologic mechanism best explains why an infant with
uncorrected biliary atresia develops progressive portal hypertension and
eventual liver failure?
A. Chronic cholestasis leads to periportal fibrosis and sinusoidal
compression, increasing intrahepatic resistance.
B. Deficient bile flow causes fat malabsorption, resulting in hepatic
steatosis and hepatocyte necrosis.
C. Elevated unconjugated bilirubin directly triggers Kupffer cell
hyperplasia and portal vein thrombosis.
D. Impaired enterohepatic circulation depletes bile acids, causing
autoimmune-mediated cholangiocyte destruction.
Correct Answer: A - Chronic cholestasis leads to periportal
fibrosis and sinusoidal compression, increasing intrahepatic
resistance.
RATIONALE
Biliary atresia causes progressive cholestasis, leading to periportal
fibrosis (biliary cirrhosis) and increased intrahepatic vascular
resistance, which manifests as portal hypertension. Fat malabsorption
and steatosis occur but are not the primary mechanism of portal
hypertension. Unconjugated bilirubin elevation and bile acid depletion
are not the direct drivers of portal fibrosis.
Question 2
A child with acute glomerulonephritis presents with hypertension and oliguria.
Which nursing action is the highest priority to prevent further renal injury?
A. Administer prescribed loop diuretic and monitor potassium levels.
B. Restrict dietary protein to 0.6 g/kg/day to reduce nitrogenous waste.
C. Initiate strict fluid restriction equal to insensible losses plus urine
output.
D. Obtain daily weights and monitor blood pressure every 4 hours.
Page 2
,Correct Answer: C - Initiate strict fluid restriction equal to
insensible losses plus urine output.
RATIONALE
In acute glomerulonephritis with oliguria and hypertension, fluid
restriction to match insensible losses plus urine output is critical to
prevent fluid overload and hypertensive complications. Diuretics may
be used but are not the first-line priority for preventing renal injury.
Protein restriction is not routinely indicated and daily
weights/monitoring are important but not the immediate action to
prevent injury.
Question 3
Which assessment finding in a child with respiratory syncytial virus (RSV)
bronchiolitis indicates impending respiratory failure and requires immediate
escalation of care?
A. Respiratory rate of 50 breaths/min with nasal flaring.
B. Oxygen saturation of 92% on room air.
C. Audible expiratory wheezing with prolonged expiration.
D. Periodic breathing with apnea lasting 15 seconds.
Correct Answer: D - Periodic breathing with apnea lasting 15
seconds.
RATIONALE
Apnea lasting >15 seconds in an infant with RSV is a sign of
impending respiratory failure and requires immediate intervention.
Tachypnea with nasal flaring and mild hypoxemia are common and
may not indicate failure. Wheezing is typical but not an immediate
escalation trigger.
Question 4
A child with tetralogy of Fallot experiences a hypercyanotic spell. Which
intervention should the nurse implement first?
Page 3
, A. Administer 100% oxygen via non-rebreather mask.
B. Place the child in a knee-chest position.
C. Administer morphine sulfate intravenously.
D. Start an intravenous bolus of normal saline.
Correct Answer: B - Place the child in a knee-chest position.
RATIONALE
The knee-chest position increases systemic vascular resistance,
reducing right-to-left shunting and improving pulmonary blood flow
during a tet spell. Oxygen and morphine are adjunctive but not the
first action. Fluid bolus is not indicated and may worsen the spell.
Question 5
Which developmental milestone is most indicative of a 9-month-old infant's
readiness for introducing finger foods?
A. Ability to sit independently and bring hands to mouth.
B. Presence of a pincer grasp to pick up small objects.
C. Demonstration of tongue thrust reflex.
D. Ability to hold a spoon with a palmar grasp.
Correct Answer: B - Presence of a pincer grasp to pick up small
objects.
RATIONALE
A pincer grasp (thumb and index finger) typically develops around 9
months and is essential for picking up finger foods safely. Sitting
independently and bringing hands to mouth occur earlier. Tongue
thrust reflex disappears by 4-6 months. Palmar grasp of a spoon is a
6-month skill.
Question 6
A child with nephrotic syndrome is receiving prednisone. Which parameter
best indicates a therapeutic response?
Page 4
Which pathophysiologic mechanism best explains why an infant with
uncorrected biliary atresia develops progressive portal hypertension and
eventual liver failure?
A. Chronic cholestasis leads to periportal fibrosis and sinusoidal
compression, increasing intrahepatic resistance.
B. Deficient bile flow causes fat malabsorption, resulting in hepatic
steatosis and hepatocyte necrosis.
C. Elevated unconjugated bilirubin directly triggers Kupffer cell
hyperplasia and portal vein thrombosis.
D. Impaired enterohepatic circulation depletes bile acids, causing
autoimmune-mediated cholangiocyte destruction.
Correct Answer: A - Chronic cholestasis leads to periportal
fibrosis and sinusoidal compression, increasing intrahepatic
resistance.
RATIONALE
Biliary atresia causes progressive cholestasis, leading to periportal
fibrosis (biliary cirrhosis) and increased intrahepatic vascular
resistance, which manifests as portal hypertension. Fat malabsorption
and steatosis occur but are not the primary mechanism of portal
hypertension. Unconjugated bilirubin elevation and bile acid depletion
are not the direct drivers of portal fibrosis.
Question 2
A child with acute glomerulonephritis presents with hypertension and oliguria.
Which nursing action is the highest priority to prevent further renal injury?
A. Administer prescribed loop diuretic and monitor potassium levels.
B. Restrict dietary protein to 0.6 g/kg/day to reduce nitrogenous waste.
C. Initiate strict fluid restriction equal to insensible losses plus urine
output.
D. Obtain daily weights and monitor blood pressure every 4 hours.
Page 2
,Correct Answer: C - Initiate strict fluid restriction equal to
insensible losses plus urine output.
RATIONALE
In acute glomerulonephritis with oliguria and hypertension, fluid
restriction to match insensible losses plus urine output is critical to
prevent fluid overload and hypertensive complications. Diuretics may
be used but are not the first-line priority for preventing renal injury.
Protein restriction is not routinely indicated and daily
weights/monitoring are important but not the immediate action to
prevent injury.
Question 3
Which assessment finding in a child with respiratory syncytial virus (RSV)
bronchiolitis indicates impending respiratory failure and requires immediate
escalation of care?
A. Respiratory rate of 50 breaths/min with nasal flaring.
B. Oxygen saturation of 92% on room air.
C. Audible expiratory wheezing with prolonged expiration.
D. Periodic breathing with apnea lasting 15 seconds.
Correct Answer: D - Periodic breathing with apnea lasting 15
seconds.
RATIONALE
Apnea lasting >15 seconds in an infant with RSV is a sign of
impending respiratory failure and requires immediate intervention.
Tachypnea with nasal flaring and mild hypoxemia are common and
may not indicate failure. Wheezing is typical but not an immediate
escalation trigger.
Question 4
A child with tetralogy of Fallot experiences a hypercyanotic spell. Which
intervention should the nurse implement first?
Page 3
, A. Administer 100% oxygen via non-rebreather mask.
B. Place the child in a knee-chest position.
C. Administer morphine sulfate intravenously.
D. Start an intravenous bolus of normal saline.
Correct Answer: B - Place the child in a knee-chest position.
RATIONALE
The knee-chest position increases systemic vascular resistance,
reducing right-to-left shunting and improving pulmonary blood flow
during a tet spell. Oxygen and morphine are adjunctive but not the
first action. Fluid bolus is not indicated and may worsen the spell.
Question 5
Which developmental milestone is most indicative of a 9-month-old infant's
readiness for introducing finger foods?
A. Ability to sit independently and bring hands to mouth.
B. Presence of a pincer grasp to pick up small objects.
C. Demonstration of tongue thrust reflex.
D. Ability to hold a spoon with a palmar grasp.
Correct Answer: B - Presence of a pincer grasp to pick up small
objects.
RATIONALE
A pincer grasp (thumb and index finger) typically develops around 9
months and is essential for picking up finger foods safely. Sitting
independently and bringing hands to mouth occur earlier. Tongue
thrust reflex disappears by 4-6 months. Palmar grasp of a spoon is a
6-month skill.
Question 6
A child with nephrotic syndrome is receiving prednisone. Which parameter
best indicates a therapeutic response?
Page 4
