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NR 328 Pediatric Nursing Exam 2 2026/2027 Actual
Exam | Verified Q&A with Detailed Rationales | Grade A
Study Guide.
1. What physiologic factor predisposes infants to fluid imbalances?
A. Decreased daily exchange of extracellular fluid
B. Lower metabolic rate
C. Immature kidney functioning
D. Decreased body surface area
CORRECT ANSWER: C. Immature kidney functioning
Rationale: Infant kidneys are functionally immature, leading to inefficient excretion of
waste and an inability to concentrate urine effectively. This, combined with a high body
surface area to mass ratio and higher metabolic rate, increases their risk for
dehydration.
2. What is the daily maintenance fluid requirement for a 14 kg child?
A. 1100 mL
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B. 1200 mL
C. 1300 mL
D. 1400 mL
CORRECT ANSWER: B. 1200 mL
Rationale: Use the 4-2-1 rule: 100 mL/kg for the first 10 kg (1000 mL) + 50 mL/kg for the
next 4 kg (200 mL) = 1200 mL/day.
3. An infant in the ED has poor skin turgor, weight loss, lethargy, tachycardia, and
tachypnea. These findings are most suggestive of:
A. Sodium depletion
B. Water depletion (dehydration)
C. Water excess
D. Potassium excess
CORRECT ANSWER: B. Water depletion (dehydration)
Rationale: These are classic signs of dehydration. Water excess (overhydration) presents
with edema and weight gain.
4. What is the primary physiologic mechanism for edema formation following a major
burn?
A. Diminished hydrostatic pressure
B. Increased capillary permeability
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C. Decreased capillary permeability
D. Vasoconstriction
CORRECT ANSWER: B. Increased capillary permeability
Rationale: Burn injury causes massive capillary leak, allowing plasma proteins and fluid
to shift into the interstitial space, causing edema. This peaks 8-24 hours post-injury.
5. What is the most immediate threat to life for a child with major thermal injuries?
A. Systemic sepsis
B. Shock and airway compromise
C. Local infection
D. Anemia
CORRECT ANSWER: B. Shock and airway compromise
Rationale: During the emergent phase, hypovolemic shock from fluid shifts and airway
edema/obstruction from inhalation injury are the primary life threats.
6. After the acute stage of a burn injury, what is the primary complication during
healing?
A. Renal shutdown
B. Asphyxia
C. Infection
D. Shock
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CORRECT ANSWER: C. Infection
Rationale: The compromised skin barrier and nonviable tissue make the burn wound
highly susceptible to local and systemic infection during the healing phase.
7. What is the most reliable indicator of adequate fluid resuscitation in a small child
with burns?
A. Absence of thirst
B. Urinary output of 1-2 mL/kg/hr
C. Falling hematocrit
D. Increased seepage from the burn wound
CORRECT ANSWER: B. Urinary output of 1-2 mL/kg/hr
Rationale: Adequate end-organ perfusion is best reflected by urine output. The goal for
children <30 kg is 1-2 mL/kg/hr.
8. What intervention is contraindicated for a child with suspected appendicitis?
A. Palpating the abdomen
B. Administering an enema
C. Giving antipyretics for fever
D. Administering antibiotics
NR 328 Pediatric Nursing Exam 2 2026/2027 Actual
Exam | Verified Q&A with Detailed Rationales | Grade A
Study Guide.
1. What physiologic factor predisposes infants to fluid imbalances?
A. Decreased daily exchange of extracellular fluid
B. Lower metabolic rate
C. Immature kidney functioning
D. Decreased body surface area
CORRECT ANSWER: C. Immature kidney functioning
Rationale: Infant kidneys are functionally immature, leading to inefficient excretion of
waste and an inability to concentrate urine effectively. This, combined with a high body
surface area to mass ratio and higher metabolic rate, increases their risk for
dehydration.
2. What is the daily maintenance fluid requirement for a 14 kg child?
A. 1100 mL
,2|Page
B. 1200 mL
C. 1300 mL
D. 1400 mL
CORRECT ANSWER: B. 1200 mL
Rationale: Use the 4-2-1 rule: 100 mL/kg for the first 10 kg (1000 mL) + 50 mL/kg for the
next 4 kg (200 mL) = 1200 mL/day.
3. An infant in the ED has poor skin turgor, weight loss, lethargy, tachycardia, and
tachypnea. These findings are most suggestive of:
A. Sodium depletion
B. Water depletion (dehydration)
C. Water excess
D. Potassium excess
CORRECT ANSWER: B. Water depletion (dehydration)
Rationale: These are classic signs of dehydration. Water excess (overhydration) presents
with edema and weight gain.
4. What is the primary physiologic mechanism for edema formation following a major
burn?
A. Diminished hydrostatic pressure
B. Increased capillary permeability
,3|Page
C. Decreased capillary permeability
D. Vasoconstriction
CORRECT ANSWER: B. Increased capillary permeability
Rationale: Burn injury causes massive capillary leak, allowing plasma proteins and fluid
to shift into the interstitial space, causing edema. This peaks 8-24 hours post-injury.
5. What is the most immediate threat to life for a child with major thermal injuries?
A. Systemic sepsis
B. Shock and airway compromise
C. Local infection
D. Anemia
CORRECT ANSWER: B. Shock and airway compromise
Rationale: During the emergent phase, hypovolemic shock from fluid shifts and airway
edema/obstruction from inhalation injury are the primary life threats.
6. After the acute stage of a burn injury, what is the primary complication during
healing?
A. Renal shutdown
B. Asphyxia
C. Infection
D. Shock
, 4|Page
CORRECT ANSWER: C. Infection
Rationale: The compromised skin barrier and nonviable tissue make the burn wound
highly susceptible to local and systemic infection during the healing phase.
7. What is the most reliable indicator of adequate fluid resuscitation in a small child
with burns?
A. Absence of thirst
B. Urinary output of 1-2 mL/kg/hr
C. Falling hematocrit
D. Increased seepage from the burn wound
CORRECT ANSWER: B. Urinary output of 1-2 mL/kg/hr
Rationale: Adequate end-organ perfusion is best reflected by urine output. The goal for
children <30 kg is 1-2 mL/kg/hr.
8. What intervention is contraindicated for a child with suspected appendicitis?
A. Palpating the abdomen
B. Administering an enema
C. Giving antipyretics for fever
D. Administering antibiotics
