NURS 307 | NURS307 Exam 3: Pediatrics - WCU
Updated and Latest Questions and Correct
Answers with Rationale
1. A 4-week-old infant is brought to the clinic with a history of projectile, non-bilious vomiting
after feedings. The nurse palpates an olive-shaped mass in the right upper quadrant. Which
condition does the nurse suspect?
A. Intussusception
B. Gastroesophageal reflux
C. Hypertrophic pyloric stenosis
D. Hirschsprung disease
Correct Answer: C
Rationale: Hypertrophic pyloric stenosis is characterized by an olive-shaped mass in the
epigastrium. Projectile vomiting typically occurs shortly after feeding and is non-bilious
because the obstruction is proximal to the bile duct. Diagnosis is usually confirmed through
ultrasound showing the thickened pylorus. The primary treatment for this condition is a
surgical procedure known as a pyloromyotomy. Preoperative care focuses on correcting
fluid and electrolyte imbalances caused by vomiting.
2. A child is admitted with suspected intussusception. Which clinical manifestation should the
nurse expect to observe?
A. Ribbon-like, foul-smelling stools
B. Steatorrhea
C. Currant jelly-like stools
D. Hard, pebble-like stools
Correct Answer: C
Rationale: Intussusception occurs when one segment of the bowel telescopes into another,
causing obstruction. The classic sign of this condition is currant jelly-like stools containing
blood and mucus. Infants often present with sudden, paroxysmal abdominal pain and
drawing the knees to the chest. An air or saline enema is often used for both diagnosis and
non-surgical reduction. If the child passes a normal brown stool, the nurse must report it as
it indicates spontaneous resolution.
3. A newborn has not passed meconium within the first 48 hours of life. The nurse notes
abdominal distention and liquid ribbon-like stools. What is the most likely diagnosis?
A. Celiac disease
,B. Appendicitis
C. Hirschsprung disease
D. Biliary atresia
Correct Answer: C
Rationale: Hirschsprung disease is a congenital anomaly resulting in the absence of
ganglion cells in the colon. This lack of innervation leads to a lack of peristalsis and
functional bowel obstruction. Common symptoms include failure to pass meconium,
abdominal distention, and ribbon-like stools in older children. Definitive diagnosis requires
a rectal biopsy to confirm the absence of ganglion cells. Treatment involves surgical
removal of the aganglionic section of the bowel.
4. A 10-year-old child with Type 1 Diabetes Mellitus presents with shakiness, diaphoresis, and
pallor. What is the nurse’s priority action?
A. Administer a dose of rapid-acting insulin
B. Administer 15 grams of simple carbohydrates
C. Check the blood glucose level
D. Call the healthcare provider immediately
Correct Answer: C
Rationale: The clinical signs of shakiness and diaphoresis strongly suggest hypoglycemia
in a diabetic patient. The nurse must first check the blood glucose level to confirm the
suspicion before intervening. If the blood sugar is low, the ‘rule of 15’ should be
implemented immediately. Following the 15 grams of simple sugar, a complex carb and
protein snack should be given if the next meal is far off. Patient safety relies on rapid
identification and treatment of low blood glucose levels.
5. A child is diagnosed with Diabetic Ketoacidosis (DKA). Which IV fluid order should the
nurse expect to initiate first?
A. 0.45% Normal Saline with 20 mEq KCl
B. 0.9% Normal Saline bolus
C. Dextrose 5% in water
D. Dextrose 5% in 0.9% Normal Saline
Correct Answer: B
Rationale: Initial management of DKA focuses on re-establishing fluid volume to treat
dehydration and shock. A bolus of isotonic saline, such as 0.9% NS, is administered to
improve perfusion. Insulin therapy is typically started after initial fluid resuscitation has
begun to avoid rapid shifts. Potassium is added to subsequent fluids only after ensuring
, adequate renal function and urine output. Continuous monitoring of glucose and
electrolytes is essential during the recovery phase.
6. Which assessment finding is a sign of increased intracranial pressure (ICP) specific to an
infant?
A. Nausea and projectile vomiting
B. Bulging fontanels
C. Diplopia and blurred vision
D. Headache that worsens with coughing
Correct Answer: B
Rationale: Infants have open cranial sutures and fontanels which allow for some
expansion during increased ICP. A bulging or tense fontanel is a hallmark sign of pressure
within the infant’s skull. Other signs in infants include high-pitched crying, irritability, and
a rapidly increasing head circumference. Older children might report headaches or double
vision, but these are not possible in non-verbal infants. Early detection of these signs is
vital to prevent permanent neurological damage.
7. A nurse is reviewing the cerebrospinal fluid (CSF) analysis of a child with suspected
bacterial meningitis. Which results are consistent with this diagnosis?
A. Clear fluid, low protein, high glucose
B. Cloudy fluid, high protein, low glucose
C. Cloudy fluid, low protein, low glucose
D. Clear fluid, high protein, high glucose
Correct Answer: B
Rationale: Bacterial meningitis typically causes the CSF to appear cloudy or turbid due to
the presence of bacteria and WBCs. Protein levels increase because of the inflammatory
response and bacterial byproducts in the fluid. Glucose levels decrease as the bacteria
consume the glucose for energy. These findings help differentiate bacterial meningitis from
viral meningitis, where glucose is usually normal. Proper interpretation of lumbar puncture
results is critical for starting appropriate antibiotic therapy.
8. A child is diagnosed with Celiac disease. Which food item should the nurse instruct the
parents to remove from the child’s diet?
A. Wheat crackers
B. Corn tortillas
C. Rice cakes
D. Fresh oranges
Updated and Latest Questions and Correct
Answers with Rationale
1. A 4-week-old infant is brought to the clinic with a history of projectile, non-bilious vomiting
after feedings. The nurse palpates an olive-shaped mass in the right upper quadrant. Which
condition does the nurse suspect?
A. Intussusception
B. Gastroesophageal reflux
C. Hypertrophic pyloric stenosis
D. Hirschsprung disease
Correct Answer: C
Rationale: Hypertrophic pyloric stenosis is characterized by an olive-shaped mass in the
epigastrium. Projectile vomiting typically occurs shortly after feeding and is non-bilious
because the obstruction is proximal to the bile duct. Diagnosis is usually confirmed through
ultrasound showing the thickened pylorus. The primary treatment for this condition is a
surgical procedure known as a pyloromyotomy. Preoperative care focuses on correcting
fluid and electrolyte imbalances caused by vomiting.
2. A child is admitted with suspected intussusception. Which clinical manifestation should the
nurse expect to observe?
A. Ribbon-like, foul-smelling stools
B. Steatorrhea
C. Currant jelly-like stools
D. Hard, pebble-like stools
Correct Answer: C
Rationale: Intussusception occurs when one segment of the bowel telescopes into another,
causing obstruction. The classic sign of this condition is currant jelly-like stools containing
blood and mucus. Infants often present with sudden, paroxysmal abdominal pain and
drawing the knees to the chest. An air or saline enema is often used for both diagnosis and
non-surgical reduction. If the child passes a normal brown stool, the nurse must report it as
it indicates spontaneous resolution.
3. A newborn has not passed meconium within the first 48 hours of life. The nurse notes
abdominal distention and liquid ribbon-like stools. What is the most likely diagnosis?
A. Celiac disease
,B. Appendicitis
C. Hirschsprung disease
D. Biliary atresia
Correct Answer: C
Rationale: Hirschsprung disease is a congenital anomaly resulting in the absence of
ganglion cells in the colon. This lack of innervation leads to a lack of peristalsis and
functional bowel obstruction. Common symptoms include failure to pass meconium,
abdominal distention, and ribbon-like stools in older children. Definitive diagnosis requires
a rectal biopsy to confirm the absence of ganglion cells. Treatment involves surgical
removal of the aganglionic section of the bowel.
4. A 10-year-old child with Type 1 Diabetes Mellitus presents with shakiness, diaphoresis, and
pallor. What is the nurse’s priority action?
A. Administer a dose of rapid-acting insulin
B. Administer 15 grams of simple carbohydrates
C. Check the blood glucose level
D. Call the healthcare provider immediately
Correct Answer: C
Rationale: The clinical signs of shakiness and diaphoresis strongly suggest hypoglycemia
in a diabetic patient. The nurse must first check the blood glucose level to confirm the
suspicion before intervening. If the blood sugar is low, the ‘rule of 15’ should be
implemented immediately. Following the 15 grams of simple sugar, a complex carb and
protein snack should be given if the next meal is far off. Patient safety relies on rapid
identification and treatment of low blood glucose levels.
5. A child is diagnosed with Diabetic Ketoacidosis (DKA). Which IV fluid order should the
nurse expect to initiate first?
A. 0.45% Normal Saline with 20 mEq KCl
B. 0.9% Normal Saline bolus
C. Dextrose 5% in water
D. Dextrose 5% in 0.9% Normal Saline
Correct Answer: B
Rationale: Initial management of DKA focuses on re-establishing fluid volume to treat
dehydration and shock. A bolus of isotonic saline, such as 0.9% NS, is administered to
improve perfusion. Insulin therapy is typically started after initial fluid resuscitation has
begun to avoid rapid shifts. Potassium is added to subsequent fluids only after ensuring
, adequate renal function and urine output. Continuous monitoring of glucose and
electrolytes is essential during the recovery phase.
6. Which assessment finding is a sign of increased intracranial pressure (ICP) specific to an
infant?
A. Nausea and projectile vomiting
B. Bulging fontanels
C. Diplopia and blurred vision
D. Headache that worsens with coughing
Correct Answer: B
Rationale: Infants have open cranial sutures and fontanels which allow for some
expansion during increased ICP. A bulging or tense fontanel is a hallmark sign of pressure
within the infant’s skull. Other signs in infants include high-pitched crying, irritability, and
a rapidly increasing head circumference. Older children might report headaches or double
vision, but these are not possible in non-verbal infants. Early detection of these signs is
vital to prevent permanent neurological damage.
7. A nurse is reviewing the cerebrospinal fluid (CSF) analysis of a child with suspected
bacterial meningitis. Which results are consistent with this diagnosis?
A. Clear fluid, low protein, high glucose
B. Cloudy fluid, high protein, low glucose
C. Cloudy fluid, low protein, low glucose
D. Clear fluid, high protein, high glucose
Correct Answer: B
Rationale: Bacterial meningitis typically causes the CSF to appear cloudy or turbid due to
the presence of bacteria and WBCs. Protein levels increase because of the inflammatory
response and bacterial byproducts in the fluid. Glucose levels decrease as the bacteria
consume the glucose for energy. These findings help differentiate bacterial meningitis from
viral meningitis, where glucose is usually normal. Proper interpretation of lumbar puncture
results is critical for starting appropriate antibiotic therapy.
8. A child is diagnosed with Celiac disease. Which food item should the nurse instruct the
parents to remove from the child’s diet?
A. Wheat crackers
B. Corn tortillas
C. Rice cakes
D. Fresh oranges
