COMPREHENSIVE NURSING LICENSURE &
PEDIATRIC CERTIFICATION EXAMINATION
Focus: Pediatric Nephrology, Acute Glomerulonephritis, Fluid Balance,
& Advanced Clinical Management (200 Questions)
Examination Overview & Guidelines
This examination comprises 200 evidence-based multiple-choice
questions designed for registered nurses and advanced nursing students
preparing for pediatric specialty certification or licensure exams. The
questions thoroughly examine pathophysiology, clinical assessment,
laboratory interpretation, pharmacological interventions, and nursing
management of acute glomerulonephritis and related pediatric renal
disorders.
Complete Examination Questions (1 - 200)
Question 1: A nurse is assessing a preschooler who has acute
glomerulonephritis. Which of the following findings is the most
reliable indicator of fluid balance status during acute treatment?
A) Serum blood urea nitrogen (BUN) and creatinine levels
B) Daily accurate body weight measurements
C) 24-hour urine specific gravity and protein excretion
D) Degree of peripheral and periorbital edema
Correct Answer: B
Rationale for Q1: Daily body weight is the single most sensitive and
reliable indicator of fluid volume status in children with acute
glomerulonephritis. (Clinical Competency Domain: Pediatric
Nephrology & Fluid Management - Ref ID #1047)ophagy.
,Question 2: When evaluating a pediatric client with acute post-
streptococcal glomerulonephritis (APSGN), which finding requires
immediate primary provider notification?
A) Blood pressure significantly above the 95th percentile for age and
height
B) Moderate periorbital edema upon awakening
C) Trace proteinuria and dark, tea-colored urine
D) Mild lethargy and decreased appetite
Correct Answer: A
Rationale for Q2: Hypertension is a hallmark of APSGN caused by
hypervolemia and reduced GFR, requiring prompt intervention to
prevent encephalopathy. (Clinical Competency Domain: Pediatric
Nephrology & Fluid Management - Ref ID #2094)ophagy.
Question 3: A nurse is monitoring intake and output for a child with
acute glomerulonephritis. Which finding indicates effective diuretic
therapy?
A) Urine output below 0.5 mL/kg/hr
B) Urine output ranging from 1 to 2 mL/kg/hr with a pale yellow
color
C) Specific gravity fixed at 1.035
D) Total urine volume matching total fluid restriction exactly
Correct Answer: B
Rationale for Q3: Normal urine output of 1 to 2 mL/kg/hr indicates
adequate renal perfusion and effective resolution of oliguria.
(Clinical Competency Domain: Pediatric Nephrology & Fluid
Management - Ref ID #3141)ophagy.
Question 4: Which pathophysiological mechanism causes edema and
hypertension in acute post-streptococcal glomerulonephritis?
, A) Primary renal tubular sodium wasting
B) Immune-complex deposition leading to decreased glomerular
filtration rate (GFR)
C) Hypoalbuminemia from liver failure
D) Direct bacterial invasion of renal tissue
Correct Answer: B
Rationale for Q4: APSGN is immune-complex mediated, leading to
glomerular inflammation, reduced GFR, and subsequent salt/water
retention. (Clinical Competency Domain: Pediatric Nephrology &
Fluid Management - Ref ID #4188)ophagy.
Question 5: Which laboratory finding specifically supports a recent
streptococcal infection in a child with glomerulonephritis?
A) Elevated ESR only
B) Elevated antistreptolysin-O (ASO) titer
C) Decreased serum IgG
D) Elevated C3 complement level
Correct Answer: B
Rationale for Q5: An elevated ASO titer confirms recent group A
beta-hemolytic streptococcal infection. (Clinical Competency
Domain: Pediatric Nephrology & Fluid Management - Ref ID
#5235)ophagy.
Question 6: Which urinalysis finding is diagnostic for acute
glomerulonephritis?
A) Heavy glycosuria
B) Gross hematuria, dysmorphic red blood cells, and red blood cell
casts
C) Alkaline pH with triple phosphate crystals
D) Absence of protein with marked pyuria
, Correct Answer: B
Rationale for Q6: Dysmorphic red cells and red cell casts are
definitive markers of glomerular origin hematuria. (Clinical
Competency Domain: Pediatric Nephrology & Fluid Management -
Ref ID #6282)ophagy.
Question 7: A child with acute glomerulonephritis has a serum
potassium level of 5.9 mEq/L. What is the priority nursing
intervention?
A) Encourage oral fluids to flush potassium
B) Prepare for immediate cardiac monitoring and treatment of
hyperkalemia
C) Administer IV potassium chloride supplement
D) Apply warm compresses to extremities
Correct Answer: B
Rationale for Q7: Hyperkalemia is life-threatening and requires
immediate cardiac monitoring and interventions such as calcium
gluconate, insulin/glucose, or kayexalate. (Clinical Competency
Domain: Pediatric Nephrology & Fluid Management - Ref ID
#7329)ophagy.
Question 8: What dietary restriction is commonly prescribed during
the acute phase of glomerulonephritis with oliguria and
hypertension?
A) High sodium, high protein diet
B) Sodium and fluid restriction, with potassium restriction if oliguric
C) Unlimited fluids and regular protein intake
D) Low carbohydrate, high fat diet
Correct Answer: B
Rationale for Q8: Sodium and fluid restrictions are necessary to
PEDIATRIC CERTIFICATION EXAMINATION
Focus: Pediatric Nephrology, Acute Glomerulonephritis, Fluid Balance,
& Advanced Clinical Management (200 Questions)
Examination Overview & Guidelines
This examination comprises 200 evidence-based multiple-choice
questions designed for registered nurses and advanced nursing students
preparing for pediatric specialty certification or licensure exams. The
questions thoroughly examine pathophysiology, clinical assessment,
laboratory interpretation, pharmacological interventions, and nursing
management of acute glomerulonephritis and related pediatric renal
disorders.
Complete Examination Questions (1 - 200)
Question 1: A nurse is assessing a preschooler who has acute
glomerulonephritis. Which of the following findings is the most
reliable indicator of fluid balance status during acute treatment?
A) Serum blood urea nitrogen (BUN) and creatinine levels
B) Daily accurate body weight measurements
C) 24-hour urine specific gravity and protein excretion
D) Degree of peripheral and periorbital edema
Correct Answer: B
Rationale for Q1: Daily body weight is the single most sensitive and
reliable indicator of fluid volume status in children with acute
glomerulonephritis. (Clinical Competency Domain: Pediatric
Nephrology & Fluid Management - Ref ID #1047)ophagy.
,Question 2: When evaluating a pediatric client with acute post-
streptococcal glomerulonephritis (APSGN), which finding requires
immediate primary provider notification?
A) Blood pressure significantly above the 95th percentile for age and
height
B) Moderate periorbital edema upon awakening
C) Trace proteinuria and dark, tea-colored urine
D) Mild lethargy and decreased appetite
Correct Answer: A
Rationale for Q2: Hypertension is a hallmark of APSGN caused by
hypervolemia and reduced GFR, requiring prompt intervention to
prevent encephalopathy. (Clinical Competency Domain: Pediatric
Nephrology & Fluid Management - Ref ID #2094)ophagy.
Question 3: A nurse is monitoring intake and output for a child with
acute glomerulonephritis. Which finding indicates effective diuretic
therapy?
A) Urine output below 0.5 mL/kg/hr
B) Urine output ranging from 1 to 2 mL/kg/hr with a pale yellow
color
C) Specific gravity fixed at 1.035
D) Total urine volume matching total fluid restriction exactly
Correct Answer: B
Rationale for Q3: Normal urine output of 1 to 2 mL/kg/hr indicates
adequate renal perfusion and effective resolution of oliguria.
(Clinical Competency Domain: Pediatric Nephrology & Fluid
Management - Ref ID #3141)ophagy.
Question 4: Which pathophysiological mechanism causes edema and
hypertension in acute post-streptococcal glomerulonephritis?
, A) Primary renal tubular sodium wasting
B) Immune-complex deposition leading to decreased glomerular
filtration rate (GFR)
C) Hypoalbuminemia from liver failure
D) Direct bacterial invasion of renal tissue
Correct Answer: B
Rationale for Q4: APSGN is immune-complex mediated, leading to
glomerular inflammation, reduced GFR, and subsequent salt/water
retention. (Clinical Competency Domain: Pediatric Nephrology &
Fluid Management - Ref ID #4188)ophagy.
Question 5: Which laboratory finding specifically supports a recent
streptococcal infection in a child with glomerulonephritis?
A) Elevated ESR only
B) Elevated antistreptolysin-O (ASO) titer
C) Decreased serum IgG
D) Elevated C3 complement level
Correct Answer: B
Rationale for Q5: An elevated ASO titer confirms recent group A
beta-hemolytic streptococcal infection. (Clinical Competency
Domain: Pediatric Nephrology & Fluid Management - Ref ID
#5235)ophagy.
Question 6: Which urinalysis finding is diagnostic for acute
glomerulonephritis?
A) Heavy glycosuria
B) Gross hematuria, dysmorphic red blood cells, and red blood cell
casts
C) Alkaline pH with triple phosphate crystals
D) Absence of protein with marked pyuria
, Correct Answer: B
Rationale for Q6: Dysmorphic red cells and red cell casts are
definitive markers of glomerular origin hematuria. (Clinical
Competency Domain: Pediatric Nephrology & Fluid Management -
Ref ID #6282)ophagy.
Question 7: A child with acute glomerulonephritis has a serum
potassium level of 5.9 mEq/L. What is the priority nursing
intervention?
A) Encourage oral fluids to flush potassium
B) Prepare for immediate cardiac monitoring and treatment of
hyperkalemia
C) Administer IV potassium chloride supplement
D) Apply warm compresses to extremities
Correct Answer: B
Rationale for Q7: Hyperkalemia is life-threatening and requires
immediate cardiac monitoring and interventions such as calcium
gluconate, insulin/glucose, or kayexalate. (Clinical Competency
Domain: Pediatric Nephrology & Fluid Management - Ref ID
#7329)ophagy.
Question 8: What dietary restriction is commonly prescribed during
the acute phase of glomerulonephritis with oliguria and
hypertension?
A) High sodium, high protein diet
B) Sodium and fluid restriction, with potassium restriction if oliguric
C) Unlimited fluids and regular protein intake
D) Low carbohydrate, high fat diet
Correct Answer: B
Rationale for Q8: Sodium and fluid restrictions are necessary to
