Keiser University
Course Code: NUR2310C
Course Title: Pediatric Nursing
Credit Hours:8.0
Exam: Final Exam
Date:2026
True or False: In a child diagnosed with nephrotic syndrome, the characteristic generalized edema
is primarily caused by a decrease in capillary hydrostatic pressure.
Correct Answer: False
Rationale: The edema in nephrotic syndrome is caused by a decrease in colloidal osmotic (oncotic)
pressure. Massive proteinuria leads to hypoalbuminemia, which reduces the "pulling" force that
keeps fluid in the vascular space, allowing it to leak into the interstitium.
A 2 month old infant is admitted with suspected pyloric stenosis. The nurse should palpate the
abdomen, specifically looking for a hard, olive shaped mass in which anatomical region?
Fill in the blank
Correct Answer: Right Upper Quadrant (RUQ) (or epigastrium)
Rationale: Hypertrophy of the pylorus creates a tangible mass located just to the right of the
midline in the upper abdomen. This mass is a hallmark diagnostic finding alongside projectile, non
bilious vomiting.
Which laboratory finding is considered the "gold standard" for the definitive diagnosis of cystic
fibrosis in a pediatric patient?
A. Fecal fat collection over 72 hours
B. Presence of the Delta F508 mutation on a blood panel
C. Sweat chloride concentration greater than 60 mEq/L
D. Pulmonary function test showing obstructive patterns
Correct Answer: C
Rationale: While genetic testing or stool samples provide supportive data, the sweat chloride test
remains the gold standard diagnosis because it measures the defective chloride transport
characteristic of the disease.
True or False: A nurse assessing a 10 year old with a suspected appendicitis should expect the
patient to experience the most intense pain when pressure is applied directly to McBurney’s point
during palpation.
Correct Answer: False
Rationale: The hallmark of peritoneal irritation in appendicitis is "rebound tenderness," where the
pain is more severe upon the sudden release of pressure rather than the application of pressure.
A toddler is brought to the emergency department after ingesting an unknown quantity of
acetaminophen. The nurse anticipates the administration of which specific pharmacological
1
,antidote?
Fill in the blank
Correct Answer: N-acetylcysteine (Mucomyst)
Rationale: N-acetylcysteine acts by replenishing glutathione stores in the liver, which allows the
body to neutralize the toxic metabolite of acetaminophen (NAPQI) and prevent hepatic necrosis.
An 8 year old child with Type 1 Diabetes is found shaky, diaphoretic, and confused. The nurse
measures the blood glucose and finds it is 42 mg/dL. The child is conscious and able to swallow.
What is the most appropriate first intervention?
A. Administer 1 mg of glucagon IM
B. Provide 15 grams of simple carbohydrates such as 4 ounces of orange juice
C. Initiate a 50 percent dextrose IV bolus
D. Offer a high protein snack like peanut butter and crackers
Correct Answer: B
Rationale: For conscious patients with hypoglycemia, the "Rule of 15" is the standard: 15 grams of
fast acting carbs should be given first to raise glucose quickly. Protein and complex carbs are used
later for stabilization but not for acute reversal.
True or False: In the immediate post operative period for a child who has undergone a
tonsillectomy, frequent swallowing or throat clearing is considered an expected finding due to local
irritation from the surgical site.
Correct Answer: False
Rationale: Frequent swallowing is the earliest and most specific sign of post operative hemorrhage.
The nurse must notify the surgical team immediately as this indicates the child is swallowing
trickling blood from the surgical bed.
A newborn with Hirschsprung disease is being prepared for surgery. The nurse knows that the
underlying pathophysiology involves a lack of ___________ cells in the distal portion of the colon.
Fill in the blank
Correct Answer: Ganglion (or Intramural Ganglionic)
Rationale: Hirschsprung disease is characterized by an aganglionic segment of the bowel, which
prevents peristalsis and leads to mechanical obstruction and proximal bowel dilation.
A 5 year old presents with a "barking" cough, inspiratory stridor, and a low grade fever. Upon X
ray of the neck, a "steeple sign" is noted. Which diagnosis is most likely?
A. Epiglottitis
B. Larynotracheobronchitis (Croup)
C. Bronchiolitis
D. Foreign body aspiration
Correct Answer: B
Rationale: The steeple sign indicates subglottic narrowing characteristic of Croup. Epiglottitis
would show a "thumbprint sign" and is a much more acute, life threatening emergency involving
higher fevers and drooling.
True or False: Standard practice for a child in a vaso occlusive sickle cell crisis is to apply cold
compresses to the painful joints to reduce inflammation and swelling.
Correct Answer: False
Rationale: Cold compresses are strictly contraindicated in sickle cell disease because cold causes
vasoconstriction, which worsens the sickling process and increases pain/ischemia. Warmth and
hydration are the standards for promoting blood flow.
The nurse is monitoring a child with a ventriculoperitoneal (VP) shunt for hydrocephalus. The
child becomes lethargic and begins to vomit. The nurse identifies "Cushing’s Triad" as a late sign
of increased intracranial pressure. This triad consists of bradycardia, irregular respirations, and
___________ ___________ ___________.
Fill in the blank
2
, Correct Answer: Widening pulse pressure (or Increased Systolic BP)
Rationale: Cushing’s Triad is an ominous clinical marker indicating that the brain is struggling to
maintain perfusion in the face of severely elevated intracranial pressure.
A 3 year old is admitted with Kawasaki Disease. Which medication is administered at high doses in
the acute phase specifically to reduce the risk of coronary artery aneurysm formation?
A. Prednisone
B. Intravenous Immunoglobulin (IVIG)
C. Ibuprofen
D. Warfarin
Correct Answer: B
Rationale: High dose IVIG combined with aspirin therapy is the standard evidence based regimen
to reduce the systemic inflammation of the coronary arteries, which is the most dangerous
complication of Kawasaki disease.
True or False: A child in a skeletal traction should have the weights removed for 5 minutes every 2
hours to allow for thorough skin assessment and position changes.
Correct Answer: False
Rationale: Traction weights must never be removed or allowed to touch the floor. Traction must be
continuous to maintain alignment and prevent muscle spasms. Interruption can compromise the
integrity of the fracture repair.
A nurse is providing discharge education for a child with hemophilia A. The nurse should instruct
the parents to avoid which over the counter medication for pain relief?
Fill in the blank
Correct Answer: Aspirin (or NSAIDs/Ibuprofen)
Rationale: Aspirin and NSAIDs inhibit platelet aggregation and increase the risk of bleeding in a
patient who already lacks clotting Factor VIII. Acetaminophen is the preferred analgesic.
Which objective assessment finding is the most sensitive early indicator of a change in a pediatric
patient’s neurological status?
A. Change in pupil size and reaction
B. Abnormal posturing (decorticate)
C. Level of consciousness (LOC)
D. Decreased heart rate
Correct Answer: C
Rationale: LOC is the most sensitive indicator. Changes in pupils and vital signs are usually later
signs of neurological deterioration or impending herniation.
True or False: For an infant with Gastroesophageal Reflux (GER), the nurse should recommend
placing the infant prone after feedings to facilitate gastric emptying.
Correct Answer: False
Rationale: The American Academy of Pediatrics (AAP) mandates the "Back to Sleep" (supine)
position for all infants to reduce the risk of SIDS, regardless of the presence of GER. Post prandial
positioning should be upright or supine.
A child with a leg cast complains of severe pain that is not relieved by elevation or analgesics.
Upon assessment, the nurse notes the toes are pale, cool, and there is pain with passive movement.
This is technically known as ___________ ___________.
Fill in the blank
Correct Answer: Compartment Syndrome
Rationale: Compartment syndrome is a surgical emergency where increased pressure within the
fascia compromises circulation. The "Pain out of proportion to injury" is the earliest hallmark sign.
A 2 year old is diagnosed with intussusception. Which type of stool is classically associated with
this condition?
A. Ribbon like, foul smelling stool
3
Course Code: NUR2310C
Course Title: Pediatric Nursing
Credit Hours:8.0
Exam: Final Exam
Date:2026
True or False: In a child diagnosed with nephrotic syndrome, the characteristic generalized edema
is primarily caused by a decrease in capillary hydrostatic pressure.
Correct Answer: False
Rationale: The edema in nephrotic syndrome is caused by a decrease in colloidal osmotic (oncotic)
pressure. Massive proteinuria leads to hypoalbuminemia, which reduces the "pulling" force that
keeps fluid in the vascular space, allowing it to leak into the interstitium.
A 2 month old infant is admitted with suspected pyloric stenosis. The nurse should palpate the
abdomen, specifically looking for a hard, olive shaped mass in which anatomical region?
Fill in the blank
Correct Answer: Right Upper Quadrant (RUQ) (or epigastrium)
Rationale: Hypertrophy of the pylorus creates a tangible mass located just to the right of the
midline in the upper abdomen. This mass is a hallmark diagnostic finding alongside projectile, non
bilious vomiting.
Which laboratory finding is considered the "gold standard" for the definitive diagnosis of cystic
fibrosis in a pediatric patient?
A. Fecal fat collection over 72 hours
B. Presence of the Delta F508 mutation on a blood panel
C. Sweat chloride concentration greater than 60 mEq/L
D. Pulmonary function test showing obstructive patterns
Correct Answer: C
Rationale: While genetic testing or stool samples provide supportive data, the sweat chloride test
remains the gold standard diagnosis because it measures the defective chloride transport
characteristic of the disease.
True or False: A nurse assessing a 10 year old with a suspected appendicitis should expect the
patient to experience the most intense pain when pressure is applied directly to McBurney’s point
during palpation.
Correct Answer: False
Rationale: The hallmark of peritoneal irritation in appendicitis is "rebound tenderness," where the
pain is more severe upon the sudden release of pressure rather than the application of pressure.
A toddler is brought to the emergency department after ingesting an unknown quantity of
acetaminophen. The nurse anticipates the administration of which specific pharmacological
1
,antidote?
Fill in the blank
Correct Answer: N-acetylcysteine (Mucomyst)
Rationale: N-acetylcysteine acts by replenishing glutathione stores in the liver, which allows the
body to neutralize the toxic metabolite of acetaminophen (NAPQI) and prevent hepatic necrosis.
An 8 year old child with Type 1 Diabetes is found shaky, diaphoretic, and confused. The nurse
measures the blood glucose and finds it is 42 mg/dL. The child is conscious and able to swallow.
What is the most appropriate first intervention?
A. Administer 1 mg of glucagon IM
B. Provide 15 grams of simple carbohydrates such as 4 ounces of orange juice
C. Initiate a 50 percent dextrose IV bolus
D. Offer a high protein snack like peanut butter and crackers
Correct Answer: B
Rationale: For conscious patients with hypoglycemia, the "Rule of 15" is the standard: 15 grams of
fast acting carbs should be given first to raise glucose quickly. Protein and complex carbs are used
later for stabilization but not for acute reversal.
True or False: In the immediate post operative period for a child who has undergone a
tonsillectomy, frequent swallowing or throat clearing is considered an expected finding due to local
irritation from the surgical site.
Correct Answer: False
Rationale: Frequent swallowing is the earliest and most specific sign of post operative hemorrhage.
The nurse must notify the surgical team immediately as this indicates the child is swallowing
trickling blood from the surgical bed.
A newborn with Hirschsprung disease is being prepared for surgery. The nurse knows that the
underlying pathophysiology involves a lack of ___________ cells in the distal portion of the colon.
Fill in the blank
Correct Answer: Ganglion (or Intramural Ganglionic)
Rationale: Hirschsprung disease is characterized by an aganglionic segment of the bowel, which
prevents peristalsis and leads to mechanical obstruction and proximal bowel dilation.
A 5 year old presents with a "barking" cough, inspiratory stridor, and a low grade fever. Upon X
ray of the neck, a "steeple sign" is noted. Which diagnosis is most likely?
A. Epiglottitis
B. Larynotracheobronchitis (Croup)
C. Bronchiolitis
D. Foreign body aspiration
Correct Answer: B
Rationale: The steeple sign indicates subglottic narrowing characteristic of Croup. Epiglottitis
would show a "thumbprint sign" and is a much more acute, life threatening emergency involving
higher fevers and drooling.
True or False: Standard practice for a child in a vaso occlusive sickle cell crisis is to apply cold
compresses to the painful joints to reduce inflammation and swelling.
Correct Answer: False
Rationale: Cold compresses are strictly contraindicated in sickle cell disease because cold causes
vasoconstriction, which worsens the sickling process and increases pain/ischemia. Warmth and
hydration are the standards for promoting blood flow.
The nurse is monitoring a child with a ventriculoperitoneal (VP) shunt for hydrocephalus. The
child becomes lethargic and begins to vomit. The nurse identifies "Cushing’s Triad" as a late sign
of increased intracranial pressure. This triad consists of bradycardia, irregular respirations, and
___________ ___________ ___________.
Fill in the blank
2
, Correct Answer: Widening pulse pressure (or Increased Systolic BP)
Rationale: Cushing’s Triad is an ominous clinical marker indicating that the brain is struggling to
maintain perfusion in the face of severely elevated intracranial pressure.
A 3 year old is admitted with Kawasaki Disease. Which medication is administered at high doses in
the acute phase specifically to reduce the risk of coronary artery aneurysm formation?
A. Prednisone
B. Intravenous Immunoglobulin (IVIG)
C. Ibuprofen
D. Warfarin
Correct Answer: B
Rationale: High dose IVIG combined with aspirin therapy is the standard evidence based regimen
to reduce the systemic inflammation of the coronary arteries, which is the most dangerous
complication of Kawasaki disease.
True or False: A child in a skeletal traction should have the weights removed for 5 minutes every 2
hours to allow for thorough skin assessment and position changes.
Correct Answer: False
Rationale: Traction weights must never be removed or allowed to touch the floor. Traction must be
continuous to maintain alignment and prevent muscle spasms. Interruption can compromise the
integrity of the fracture repair.
A nurse is providing discharge education for a child with hemophilia A. The nurse should instruct
the parents to avoid which over the counter medication for pain relief?
Fill in the blank
Correct Answer: Aspirin (or NSAIDs/Ibuprofen)
Rationale: Aspirin and NSAIDs inhibit platelet aggregation and increase the risk of bleeding in a
patient who already lacks clotting Factor VIII. Acetaminophen is the preferred analgesic.
Which objective assessment finding is the most sensitive early indicator of a change in a pediatric
patient’s neurological status?
A. Change in pupil size and reaction
B. Abnormal posturing (decorticate)
C. Level of consciousness (LOC)
D. Decreased heart rate
Correct Answer: C
Rationale: LOC is the most sensitive indicator. Changes in pupils and vital signs are usually later
signs of neurological deterioration or impending herniation.
True or False: For an infant with Gastroesophageal Reflux (GER), the nurse should recommend
placing the infant prone after feedings to facilitate gastric emptying.
Correct Answer: False
Rationale: The American Academy of Pediatrics (AAP) mandates the "Back to Sleep" (supine)
position for all infants to reduce the risk of SIDS, regardless of the presence of GER. Post prandial
positioning should be upright or supine.
A child with a leg cast complains of severe pain that is not relieved by elevation or analgesics.
Upon assessment, the nurse notes the toes are pale, cool, and there is pain with passive movement.
This is technically known as ___________ ___________.
Fill in the blank
Correct Answer: Compartment Syndrome
Rationale: Compartment syndrome is a surgical emergency where increased pressure within the
fascia compromises circulation. The "Pain out of proportion to injury" is the earliest hallmark sign.
A 2 year old is diagnosed with intussusception. Which type of stool is classically associated with
this condition?
A. Ribbon like, foul smelling stool
3
