PEDIATRIC NURSING ADVANCED
COMPREHENSIVE EXAM (NR 328)
QUESTIONS WITH VERIFIED ANSWERS
1. A nurse is assessing a 4-year-old child with suspected bacterial meningitis. Which clinical
manifestation should the nurse recognize as a late and ominous sign of increased intracranial
pressure (ICP)?
A. Bulging anterior fontanel
B. High-pitched, piercing cry
C. Increased irritability and restlessness
D. Bradycardia and widened pulse pressure
Answer: D
Conceptual Explanation: Bradycardia and widened pulse pressure (Cushing’s triad) are
late signs of increased ICP. Options A, B, and D are early signs, though A is specific to infants
with open fontanels.
2. In the treatment of a child with Sickle Cell Vaso-occlusive Crisis, which nursing intervention
is the highest priority?
A. Administering high-dose IV antibiotics
,B. Providing aggressive intravenous hydration
C. Applying cold compresses to painful joints
D. Restricting oral fluid intake to prevent overload
Answer: B
Conceptual Explanation: Hydration is the priority to reduce blood viscosity and prevent
further sickling. Cold compresses are contraindicated as they cause vasoconstriction.
3. A 2-year-old is admitted with suspected Laryngotracheobronchitis (Croup). The nurse
observes the child has inspiratory stridor at rest and suprasternal retractions. What is the
immediate priority action?
A. Administer oral prednisone as ordered
B. Encourage the child to drink cold liquids
C. Prepare for nebulized epinephrine administration
D. Perform a throat culture to rule out epiglottitis
Answer: C
Conceptual Explanation: Stridor at rest indicates severe airway narrowing; nebulized
racemic epinephrine provides rapid mucosal vasoconstriction. Oral steroids take longer to
work.
, 4. When planning care for a child with Tetralogy of Fallot who experiences a ‘tet spell’ during
a blood draw, what should the nurse do first?
A. Administer 100% oxygen via non-rebreather mask
B. Prepare a dose of intravenous morphine sulfate
C. Place the child in the knee-chest position
D. Initiate a bolus of isotonic saline
Answer: C
Conceptual Explanation: Knee-chest position increases systemic vascular resistance,
reducing the right-to-left shunt and improving pulmonary blood flow.
5. A 10-year-old child with Type 1 Diabetes Mellitus presents with deep, rapid respirations
and a fruity breath odor. The nurse should anticipate which initial laboratory finding?
A. Serum pH of 7.45
B. Blood glucose level of 120 mg/dL
C. Positive urine ketones and low serum bicarbonate
D. Elevated serum potassium and low BUN
Answer: C
Conceptual Explanation: These are classic signs of Diabetic Ketoacidosis (DKA),
characterized by hyperglycemia, metabolic acidosis (low pH/bicarbonate), and ketonuria.
COMPREHENSIVE EXAM (NR 328)
QUESTIONS WITH VERIFIED ANSWERS
1. A nurse is assessing a 4-year-old child with suspected bacterial meningitis. Which clinical
manifestation should the nurse recognize as a late and ominous sign of increased intracranial
pressure (ICP)?
A. Bulging anterior fontanel
B. High-pitched, piercing cry
C. Increased irritability and restlessness
D. Bradycardia and widened pulse pressure
Answer: D
Conceptual Explanation: Bradycardia and widened pulse pressure (Cushing’s triad) are
late signs of increased ICP. Options A, B, and D are early signs, though A is specific to infants
with open fontanels.
2. In the treatment of a child with Sickle Cell Vaso-occlusive Crisis, which nursing intervention
is the highest priority?
A. Administering high-dose IV antibiotics
,B. Providing aggressive intravenous hydration
C. Applying cold compresses to painful joints
D. Restricting oral fluid intake to prevent overload
Answer: B
Conceptual Explanation: Hydration is the priority to reduce blood viscosity and prevent
further sickling. Cold compresses are contraindicated as they cause vasoconstriction.
3. A 2-year-old is admitted with suspected Laryngotracheobronchitis (Croup). The nurse
observes the child has inspiratory stridor at rest and suprasternal retractions. What is the
immediate priority action?
A. Administer oral prednisone as ordered
B. Encourage the child to drink cold liquids
C. Prepare for nebulized epinephrine administration
D. Perform a throat culture to rule out epiglottitis
Answer: C
Conceptual Explanation: Stridor at rest indicates severe airway narrowing; nebulized
racemic epinephrine provides rapid mucosal vasoconstriction. Oral steroids take longer to
work.
, 4. When planning care for a child with Tetralogy of Fallot who experiences a ‘tet spell’ during
a blood draw, what should the nurse do first?
A. Administer 100% oxygen via non-rebreather mask
B. Prepare a dose of intravenous morphine sulfate
C. Place the child in the knee-chest position
D. Initiate a bolus of isotonic saline
Answer: C
Conceptual Explanation: Knee-chest position increases systemic vascular resistance,
reducing the right-to-left shunt and improving pulmonary blood flow.
5. A 10-year-old child with Type 1 Diabetes Mellitus presents with deep, rapid respirations
and a fruity breath odor. The nurse should anticipate which initial laboratory finding?
A. Serum pH of 7.45
B. Blood glucose level of 120 mg/dL
C. Positive urine ketones and low serum bicarbonate
D. Elevated serum potassium and low BUN
Answer: C
Conceptual Explanation: These are classic signs of Diabetic Ketoacidosis (DKA),
characterized by hyperglycemia, metabolic acidosis (low pH/bicarbonate), and ketonuria.
