NSG 3600 Final Exam | NSG 3600 Children’s
Health | Questions & Answers with
Rationales 2026/2027 Update
QUESTION 1
A nurse is teaching new parents about infant developmental milestones. Which
milestone should the nurse state is expected at 4 months of age?
A) Sitting unsupported
B) Rolling from abdomen to back
C) Pincer grasp development
D) Saying mama and dada with specific meaning
Answer: B
Rationale: Rolling from abdomen to back and back to abdomen typically occurs
around 4 to 5 months of age. Sitting unsupported is expected around 6 to 8
months. Pincer grasp develops around 9 to 10 months. Meaningful single words
with specific intent emerge around 10 to 12 months.
QUESTION 2
At a 9-month well-child visit, a mother expresses concern that her infant does not
yet walk independently. Which response by the nurse is best?
A) This is a significant developmental delay that requires immediate physical
therapy.
B) Most infants take their first independent steps around 12 months of age;
pulling to stand is expected now.
C) You should encourage supported walking with a baby walker immediately.
D) Infants should be walking independently by 8 months of age.
Answer: B
,Rationale: Independent walking typically occurs around 12 months with a normal
range of 9 to 15 months. At 9 months, pulling to stand, sitting well, and
transferring objects are expected milestones. Infant walkers are unsafe and
discouraged due to injury risks.
QUESTION 3
A pediatric nurse is assessing a 2-year-old child who is brought to the clinic for a
well visit. Which assessment finding would most warrant a referral for further
evaluation?
A) Using two-word phrases and telegraphic speech
B) Running with a wide-based gait and climbing stairs with two feet per step
C) Inability to speak in full sentences or tell short stories
D) Using gestures and pointing alongside simple words
Answer: C
Rationale: By 24 months of age, toddlers should be combining two words into
simple phrases. A complete absence of spoken words or inability to use two-word
combinations is a red flag for language delay and warrants formal speech and
hearing evaluation.
QUESTION 4
A school-age child is admitted with severe dehydration due to acute
gastroenteritis. The provider orders an initial fluid bolus of 20 mL/kg of isotonic
crystalloid. The child weighs 15 kg. What is the correct volume of the fluid bolus
the nurse should administer?
A) 150 mL
B) 300 mL
C) 450 mL
D) 600 mL
Answer: B
,Rationale: To calculate the fluid bolus, multiply the child's weight in kilograms by
the prescribed volume per kilogram (20 mL/kg x 15 kg = 300 mL). Isotonic
crystalloids such as 0.9% normal saline or lactated Ringer's solution are used for
rapid intravascular volume expansion in pediatric hypovolemic shock.
QUESTION 5
A pediatric patient is admitted in diabetic ketoacidosis (DKA) with a blood glucose
level of 580 mg/dL, Kussmaul respirations, and a fruity breath odor. Which
intravenous fluid should the nurse initiate first?
A) 5% Dextrose in Water with 0.45% Sodium Chloride
B) 0.9% Normal Saline for initial intravascular volume expansion
C) 3% Hypertonic Saline rapidly over 30 minutes
D) Sterile water via nasogastric tube
Answer: B
Rationale: Initial fluid resuscitation in pediatric diabetic ketoacidosis requires
rapid administration of an isotonic crystalloid such as 0.9% normal saline to
restore intravascular volume and renal perfusion before insulin therapy is
titrated. Adding dextrose occurs later when blood glucose approaches 250 to 300
mg/dL to prevent hypoglycemia and cerebral edema.
QUESTION 6
A nurse is caring for an infant diagnosed with a ventricular septal defect (VSD).
Which pathophysiological mechanism explains the development of heart failure
symptoms in this infant?
A) Decreased pulmonary vascular resistance leading to increased left-to-right
shunting
B) Increased systemic vascular resistance leading to right-to-left shunting
C) Primary obstruction of the aortic valve outflow tract
D) Complete separation of the systemic and pulmonary circulations
Answer: A
, Rationale: In infants with a VSD, physiologic pulmonary vascular resistance
decreases in the weeks following birth, which facilitates increased left-to-right
shunting through the septal defect. This results in excessive pulmonary blood
flow, volume overload on the left ventricle, and subsequent signs of congestive
heart failure.
QUESTION 7
A 3-week-old male infant presents with non-bilious projectile vomiting
immediately after feeding and a palpable olive-shaped mass in the upper right
quadrant. What is the priority nursing and medical intervention?
A) Prepare the infant for emergency surgical pyloromyotomy after correcting fluid
and electrolyte imbalances
B) Immediately administer oral antiemetics and discharge home on thickened
feeds
C) Transition the infant to whole cow's milk formula immediately
D) Position the infant flat on the back following all feeds
Answer: A
Rationale: Pyloric stenosis presents with progressive, non-bilious projectile
vomiting and a characteristic olive-shaped mass in the epigastric region.
Preoperative management requires establishing NPO status, correcting metabolic
alkalosis and electrolyte abnormalities via IV fluids, and scheduling a surgical
pyloromyotomy.
QUESTION 8
A nurse is assessing a pediatric client with suspected intussusception. Which
clinical manifestation is most characteristic of this condition?
A) Projectile bilious vomiting and olive-shaped abdominal mass
B) Currant jelly stools mixed with blood and mucus, accompanied by intermittent
colicky abdominal pain
C) Ribbon-like foul-smelling stools and abdominal distension
D) Painless bright red rectal bleeding with constipation
Health | Questions & Answers with
Rationales 2026/2027 Update
QUESTION 1
A nurse is teaching new parents about infant developmental milestones. Which
milestone should the nurse state is expected at 4 months of age?
A) Sitting unsupported
B) Rolling from abdomen to back
C) Pincer grasp development
D) Saying mama and dada with specific meaning
Answer: B
Rationale: Rolling from abdomen to back and back to abdomen typically occurs
around 4 to 5 months of age. Sitting unsupported is expected around 6 to 8
months. Pincer grasp develops around 9 to 10 months. Meaningful single words
with specific intent emerge around 10 to 12 months.
QUESTION 2
At a 9-month well-child visit, a mother expresses concern that her infant does not
yet walk independently. Which response by the nurse is best?
A) This is a significant developmental delay that requires immediate physical
therapy.
B) Most infants take their first independent steps around 12 months of age;
pulling to stand is expected now.
C) You should encourage supported walking with a baby walker immediately.
D) Infants should be walking independently by 8 months of age.
Answer: B
,Rationale: Independent walking typically occurs around 12 months with a normal
range of 9 to 15 months. At 9 months, pulling to stand, sitting well, and
transferring objects are expected milestones. Infant walkers are unsafe and
discouraged due to injury risks.
QUESTION 3
A pediatric nurse is assessing a 2-year-old child who is brought to the clinic for a
well visit. Which assessment finding would most warrant a referral for further
evaluation?
A) Using two-word phrases and telegraphic speech
B) Running with a wide-based gait and climbing stairs with two feet per step
C) Inability to speak in full sentences or tell short stories
D) Using gestures and pointing alongside simple words
Answer: C
Rationale: By 24 months of age, toddlers should be combining two words into
simple phrases. A complete absence of spoken words or inability to use two-word
combinations is a red flag for language delay and warrants formal speech and
hearing evaluation.
QUESTION 4
A school-age child is admitted with severe dehydration due to acute
gastroenteritis. The provider orders an initial fluid bolus of 20 mL/kg of isotonic
crystalloid. The child weighs 15 kg. What is the correct volume of the fluid bolus
the nurse should administer?
A) 150 mL
B) 300 mL
C) 450 mL
D) 600 mL
Answer: B
,Rationale: To calculate the fluid bolus, multiply the child's weight in kilograms by
the prescribed volume per kilogram (20 mL/kg x 15 kg = 300 mL). Isotonic
crystalloids such as 0.9% normal saline or lactated Ringer's solution are used for
rapid intravascular volume expansion in pediatric hypovolemic shock.
QUESTION 5
A pediatric patient is admitted in diabetic ketoacidosis (DKA) with a blood glucose
level of 580 mg/dL, Kussmaul respirations, and a fruity breath odor. Which
intravenous fluid should the nurse initiate first?
A) 5% Dextrose in Water with 0.45% Sodium Chloride
B) 0.9% Normal Saline for initial intravascular volume expansion
C) 3% Hypertonic Saline rapidly over 30 minutes
D) Sterile water via nasogastric tube
Answer: B
Rationale: Initial fluid resuscitation in pediatric diabetic ketoacidosis requires
rapid administration of an isotonic crystalloid such as 0.9% normal saline to
restore intravascular volume and renal perfusion before insulin therapy is
titrated. Adding dextrose occurs later when blood glucose approaches 250 to 300
mg/dL to prevent hypoglycemia and cerebral edema.
QUESTION 6
A nurse is caring for an infant diagnosed with a ventricular septal defect (VSD).
Which pathophysiological mechanism explains the development of heart failure
symptoms in this infant?
A) Decreased pulmonary vascular resistance leading to increased left-to-right
shunting
B) Increased systemic vascular resistance leading to right-to-left shunting
C) Primary obstruction of the aortic valve outflow tract
D) Complete separation of the systemic and pulmonary circulations
Answer: A
, Rationale: In infants with a VSD, physiologic pulmonary vascular resistance
decreases in the weeks following birth, which facilitates increased left-to-right
shunting through the septal defect. This results in excessive pulmonary blood
flow, volume overload on the left ventricle, and subsequent signs of congestive
heart failure.
QUESTION 7
A 3-week-old male infant presents with non-bilious projectile vomiting
immediately after feeding and a palpable olive-shaped mass in the upper right
quadrant. What is the priority nursing and medical intervention?
A) Prepare the infant for emergency surgical pyloromyotomy after correcting fluid
and electrolyte imbalances
B) Immediately administer oral antiemetics and discharge home on thickened
feeds
C) Transition the infant to whole cow's milk formula immediately
D) Position the infant flat on the back following all feeds
Answer: A
Rationale: Pyloric stenosis presents with progressive, non-bilious projectile
vomiting and a characteristic olive-shaped mass in the epigastric region.
Preoperative management requires establishing NPO status, correcting metabolic
alkalosis and electrolyte abnormalities via IV fluids, and scheduling a surgical
pyloromyotomy.
QUESTION 8
A nurse is assessing a pediatric client with suspected intussusception. Which
clinical manifestation is most characteristic of this condition?
A) Projectile bilious vomiting and olive-shaped abdominal mass
B) Currant jelly stools mixed with blood and mucus, accompanied by intermittent
colicky abdominal pain
C) Ribbon-like foul-smelling stools and abdominal distension
D) Painless bright red rectal bleeding with constipation
