NUR106 | NUR106 Pediatric Nursing Exam 3
Version 1 | Questions with Correct Answers and
Expert Explanation for Each Question | Saint Paul’s
School of Nursing
1. A nurse is caring for an infant with a large Ventricular Septal Defect (VSD). Which
clinical manifestation should the nurse expect to observe?
A. Tachypnea and poor feeding behaviors
B. Cyanosis that increases with crying
C. Bounding peripheral pulses and widened pulse pressure
D. Higher blood pressure in the arms than the legs
Correct Answer: A
Expert Explanation: A ventricular septal defect allows oxygenated blood to shunt
from the left ventricle to the right ventricle, increasing pulmonary blood flow. This
extra volume leads to pulmonary congestion and symptoms of congestive heart
failure. The infant often presents with tachypnea, diaphoresis, and fatigue during
feedings due to the increased workload of the heart. Nursing care focuses on
monitoring respiratory status and ensuring the infant consumes enough calories for
growth. Unlike cyanotic defects, VSD primarily causes signs of fluid overload in the
lungs.
,2. When teaching the parents of a child with Tetralogy of Fallot about ‘Tet spells,’
which position should the nurse instruct them to use?
A. High Fowler’s position
B. Knee-chest position
C. Supine with legs elevated
D. Prone with a pillow under the chest
Correct Answer: B
Expert Explanation: The knee-chest position increases systemic vascular
resistance, which helps reduce the right-to-left shunt across the ventricular septal
defect. By increasing pressure on the left side of the heart, more blood is forced into
the pulmonary artery for oxygenation. This intervention is the primary emergency
action for a hypercyanotic spell in a child with Tetralogy of Fallot. Parents must be
taught to recognize the sudden onset of cyanosis and deep respirations as a medical
emergency. Calmly placing the infant in this position can rapidly improve oxygen
saturation levels.
3. A 10-year-old child with Type 1 Diabetes Mellitus (T1DM) is experiencing shakiness,
hunger, and irritability. What is the priority nursing action?
A. Check the child’s blood glucose level
B. Administer a dose of rapid-acting insulin
,C. Give the child 15 grams of simple carbohydrates
D. Call the healthcare provider immediately
Correct Answer: A
Expert Explanation: The child is demonstrating classic signs of hypoglycemia, but
the nurse must first confirm the blood glucose level if a monitor is available. If
checking the glucose would delay treatment significantly, the nurse should treat the
symptoms immediately. The rule of fifteen involves giving fifteen grams of fast-
acting sugar and rechecking in fifteen minutes. After the glucose levels rise, a
complex carbohydrate and protein snack should be provided to maintain stability.
Education for the child includes learning to recognize these early autonomic
symptoms to prevent severe reactions.
4. Which medication is commonly administered to close a patent ductus arteriosus
(PDA) in a premature infant?
A. Furosemide
B. Prostalglandin E1
C. Digoxin
D. Indomethacin
Correct Answer: D
, Expert Explanation: Indomethacin is a prostaglandin inhibitor that facilitates the
closure of the ductus arteriosus in neonates. In a PDA, blood shunts from the aorta
to the pulmonary artery, leading to increased pulmonary circulation. Closing the
ductus helps prevent heart failure and pulmonary hypertension in vulnerable
infants. The nurse must monitor the infant’s renal function and platelet count while
this medication is being administered. If medical management fails, surgical ligation
or a transcatheter closure may be necessary later in life.
5. A nurse is preparing to administer Digoxin to a 4-year-old child. In which situation
should the nurse withhold the dose?
A. The child has a heart rate of 110 beats per minute
B. The child’s serum potassium level is 4.5 mEq/L
C. The child’s digoxin level is 1.2 ng/mL
D. The child is experiencing nausea and vomiting
Correct Answer: D
Expert Explanation: Nausea, vomiting, and anorexia are classic early signs of
digoxin toxicity in the pediatric population. The nurse must assess the apical pulse
for a full minute before administration and withhold the dose if the heart rate is
below age-specific norms. Digoxin toxicity is also more likely if the patient has low
potassium levels, making electrolyte monitoring essential. The therapeutic range for
Version 1 | Questions with Correct Answers and
Expert Explanation for Each Question | Saint Paul’s
School of Nursing
1. A nurse is caring for an infant with a large Ventricular Septal Defect (VSD). Which
clinical manifestation should the nurse expect to observe?
A. Tachypnea and poor feeding behaviors
B. Cyanosis that increases with crying
C. Bounding peripheral pulses and widened pulse pressure
D. Higher blood pressure in the arms than the legs
Correct Answer: A
Expert Explanation: A ventricular septal defect allows oxygenated blood to shunt
from the left ventricle to the right ventricle, increasing pulmonary blood flow. This
extra volume leads to pulmonary congestion and symptoms of congestive heart
failure. The infant often presents with tachypnea, diaphoresis, and fatigue during
feedings due to the increased workload of the heart. Nursing care focuses on
monitoring respiratory status and ensuring the infant consumes enough calories for
growth. Unlike cyanotic defects, VSD primarily causes signs of fluid overload in the
lungs.
,2. When teaching the parents of a child with Tetralogy of Fallot about ‘Tet spells,’
which position should the nurse instruct them to use?
A. High Fowler’s position
B. Knee-chest position
C. Supine with legs elevated
D. Prone with a pillow under the chest
Correct Answer: B
Expert Explanation: The knee-chest position increases systemic vascular
resistance, which helps reduce the right-to-left shunt across the ventricular septal
defect. By increasing pressure on the left side of the heart, more blood is forced into
the pulmonary artery for oxygenation. This intervention is the primary emergency
action for a hypercyanotic spell in a child with Tetralogy of Fallot. Parents must be
taught to recognize the sudden onset of cyanosis and deep respirations as a medical
emergency. Calmly placing the infant in this position can rapidly improve oxygen
saturation levels.
3. A 10-year-old child with Type 1 Diabetes Mellitus (T1DM) is experiencing shakiness,
hunger, and irritability. What is the priority nursing action?
A. Check the child’s blood glucose level
B. Administer a dose of rapid-acting insulin
,C. Give the child 15 grams of simple carbohydrates
D. Call the healthcare provider immediately
Correct Answer: A
Expert Explanation: The child is demonstrating classic signs of hypoglycemia, but
the nurse must first confirm the blood glucose level if a monitor is available. If
checking the glucose would delay treatment significantly, the nurse should treat the
symptoms immediately. The rule of fifteen involves giving fifteen grams of fast-
acting sugar and rechecking in fifteen minutes. After the glucose levels rise, a
complex carbohydrate and protein snack should be provided to maintain stability.
Education for the child includes learning to recognize these early autonomic
symptoms to prevent severe reactions.
4. Which medication is commonly administered to close a patent ductus arteriosus
(PDA) in a premature infant?
A. Furosemide
B. Prostalglandin E1
C. Digoxin
D. Indomethacin
Correct Answer: D
, Expert Explanation: Indomethacin is a prostaglandin inhibitor that facilitates the
closure of the ductus arteriosus in neonates. In a PDA, blood shunts from the aorta
to the pulmonary artery, leading to increased pulmonary circulation. Closing the
ductus helps prevent heart failure and pulmonary hypertension in vulnerable
infants. The nurse must monitor the infant’s renal function and platelet count while
this medication is being administered. If medical management fails, surgical ligation
or a transcatheter closure may be necessary later in life.
5. A nurse is preparing to administer Digoxin to a 4-year-old child. In which situation
should the nurse withhold the dose?
A. The child has a heart rate of 110 beats per minute
B. The child’s serum potassium level is 4.5 mEq/L
C. The child’s digoxin level is 1.2 ng/mL
D. The child is experiencing nausea and vomiting
Correct Answer: D
Expert Explanation: Nausea, vomiting, and anorexia are classic early signs of
digoxin toxicity in the pediatric population. The nurse must assess the apical pulse
for a full minute before administration and withhold the dose if the heart rate is
below age-specific norms. Digoxin toxicity is also more likely if the patient has low
potassium levels, making electrolyte monitoring essential. The therapeutic range for
