NUR 254 Exam 4 (Galen College of Nursing) Complete
100-Question Bank | 2026/2027 Update | Verified
Answers with Rationales
Unit 1: Hematologic & Oncologic Disorders (Qs 1-25)
1. The nurse is caring for a child who has leukemia with a white blood cell (WBC)
count of less than 1000 mm³. Which of the following should the nurse include in
the child's plan of care?
A) Administer prescribed influenza vaccination
B) Assign the child to a room with other children
C) Allow the child to play with other children who do not have a fever
D) Use sterile techniques for any procedures
*Rationale: A WBC count <1000 mm³ indicates severe neutropenia. The child is
immunocompromised and at high risk for infection. Sterile technique for all
invasive procedures is essential to prevent life-threatening infections. Live
vaccines are contraindicated, and the child should be isolated from potentially
infected individuals.*
2. The nurse is providing a teaching session to the health care staff regarding
osteosarcoma. Which of the following statements by an attendee indicates a
need for additional teaching?
A) "A common clinical manifestation is limping if a weight-bearing limb is
affected."
B) "The sternum is the most common site of this sarcoma."
C) "Children typically experience pain at the primary tumor site."
D) "In the early stage, the symptoms of this disease are usually attributed
to normal growing pains."
,Rationale: Osteosarcoma most commonly occurs in the metaphyseal growth
plates of long bones, particularly the distal femur, proximal tibia, and proximal
humerus. The sternum is NOT a common site. Pain and limping are typical
presenting symptoms often mistaken for growing pains.
3. The nurse is caring for a child who is suspected of having a Wilms' tumor.
Which of the following actions by the nurse indicates the need for additional
training?
A) Instructing the parents that the child needs to remain in bed
B) Preventing a child from playing tag in the playroom
C) Requesting a bland soft diet for the child
D) Palpating the child's abdomen
Rationale: Palpation of a Wilms' tumor (nephroblastoma) is strictly
contraindicated because it can cause seeding (rupture) of the tumor and spread
malignant cells throughout the abdominal cavity. Abdominal palpation can also
cause tumor rupture and hemorrhage.
4. The nurse is caring for a 5-year-old child who has sickle cell disease (SCD). An
assessment of the child includes respirations of 10 breaths/min and
unarousable. The child is currently on IV fluids and continuous IV morphine
sulfate. Based on the assessment information, which of the following actions
should the nurse take first?
A) Increase the IV fluids to decrease vaso-occlusion
B) Obtain a complete metabolic laboratory blood sample
C) Elevate the head of the bed to increase oxygen saturation
D) Administer naloxone to reverse the effect of the morphine
*Rationale: The child is displaying signs of opioid toxicity: respiratory depression
(RR 10, normal for a 5-year-old is 20-30) and decreased level of consciousness
(unarousable). Naloxone (Narcan) is the antidote for morphine and should be
administered immediately to reverse respiratory depression. This is a priority over
other interventions.*
,5. The nurse is admitting a child who has a vaso-occlusive sickle cell crisis. Which
of the following interventions should the nurse anticipate to be prescribed for
the child?
A) Correction of alkalosis and reduction of energy expenditure
B) Globulins and factor VIII replacement
C) Hydration and pain management
D) Electrolyte replacement and administration of heparin
Rationale: The management of a vaso-occlusive crisis focuses on hydration (to
reduce blood viscosity and prevent further sickling) and pain management (usually
with opioids). Oxygen may also be administered. Cold compresses are
contraindicated as they cause vasoconstriction.
6. The nurse working in the emergency department is caring for a child who has
hemophilia and developed a swollen knee after falling off a bicycle. The nurse is
teaching the child's parents about care when similar incidents occur at home in
the future. Which of the following actions should the nurse teach the parents?
A) Take the child to the nearest emergency department
B) Keep the child's affected knee below the level of the heart
C) Apply an ice pack and compression dressings to the knee
D) Administer recommended dose of aspirin
Rationale: The standard intervention for hemarthrosis (bleeding into the joint) is
RICE: Rest, Ice, Compression, and Elevation (above the heart). Ice causes
vasoconstriction to control bleeding. Aspirin is contraindicated due to its anti-
platelet effects.
7. The newly hired nurse is talking with the nurse preceptor about the
prevention of iron-deficiency anemia in infants. Which of the following
statements by the newly hired nurse is correct regarding prevention of this
condition?
A) "Whole cow's milk should not be given until 1 year of age with limited
daily intake."
, B) "Ferrous sulfate drops are contraindicated in infants less than 6 months
of age."
C) "Iron-fortified commercial formula should be given for the first 6 months
of life."
D) "Iron-fortified infant cereal should be introduced to infants at 10
months."
*Rationale: Whole cow's milk is introduced at 1 year but limited to 24 ounces/day
because it is a poor iron source and can lead to "milk anemia." Iron-fortified
formula is recommended, and iron-fortified cereal is introduced around 6
months. Ferrous sulfate drops are used in infants under 6 months when
indicated.*
8. The nurse is assessing a child who has severe iron deficiency anemia. Which
of the following assessment findings should the nurse expect to observe?
A) Pallor
B) Painful swelling of the hands
C) An enlarged abdomen
D) Visual disturbances
Rationale: Pallor is a hallmark sign of severe iron deficiency anemia due to
decreased hemoglobin and reduced oxygen-carrying capacity. Other signs include
fatigue, irritability, tachycardia, and spoon-shaped nails (koilonychia).
9. The nurse is caring for a 4-year-old child who is 36 hours postoperative
following removal of a Wilm's tumor. Which of the following requires
immediate follow-up by the nurse?
A) White blood cell (WBC) count of 15.0 mm³
B) Bowel sounds present in all 4 quadrants
C) Temperature of 100.4°F that occurs one time in a 24-hour period
D) Incision site is pink at the edges
100-Question Bank | 2026/2027 Update | Verified
Answers with Rationales
Unit 1: Hematologic & Oncologic Disorders (Qs 1-25)
1. The nurse is caring for a child who has leukemia with a white blood cell (WBC)
count of less than 1000 mm³. Which of the following should the nurse include in
the child's plan of care?
A) Administer prescribed influenza vaccination
B) Assign the child to a room with other children
C) Allow the child to play with other children who do not have a fever
D) Use sterile techniques for any procedures
*Rationale: A WBC count <1000 mm³ indicates severe neutropenia. The child is
immunocompromised and at high risk for infection. Sterile technique for all
invasive procedures is essential to prevent life-threatening infections. Live
vaccines are contraindicated, and the child should be isolated from potentially
infected individuals.*
2. The nurse is providing a teaching session to the health care staff regarding
osteosarcoma. Which of the following statements by an attendee indicates a
need for additional teaching?
A) "A common clinical manifestation is limping if a weight-bearing limb is
affected."
B) "The sternum is the most common site of this sarcoma."
C) "Children typically experience pain at the primary tumor site."
D) "In the early stage, the symptoms of this disease are usually attributed
to normal growing pains."
,Rationale: Osteosarcoma most commonly occurs in the metaphyseal growth
plates of long bones, particularly the distal femur, proximal tibia, and proximal
humerus. The sternum is NOT a common site. Pain and limping are typical
presenting symptoms often mistaken for growing pains.
3. The nurse is caring for a child who is suspected of having a Wilms' tumor.
Which of the following actions by the nurse indicates the need for additional
training?
A) Instructing the parents that the child needs to remain in bed
B) Preventing a child from playing tag in the playroom
C) Requesting a bland soft diet for the child
D) Palpating the child's abdomen
Rationale: Palpation of a Wilms' tumor (nephroblastoma) is strictly
contraindicated because it can cause seeding (rupture) of the tumor and spread
malignant cells throughout the abdominal cavity. Abdominal palpation can also
cause tumor rupture and hemorrhage.
4. The nurse is caring for a 5-year-old child who has sickle cell disease (SCD). An
assessment of the child includes respirations of 10 breaths/min and
unarousable. The child is currently on IV fluids and continuous IV morphine
sulfate. Based on the assessment information, which of the following actions
should the nurse take first?
A) Increase the IV fluids to decrease vaso-occlusion
B) Obtain a complete metabolic laboratory blood sample
C) Elevate the head of the bed to increase oxygen saturation
D) Administer naloxone to reverse the effect of the morphine
*Rationale: The child is displaying signs of opioid toxicity: respiratory depression
(RR 10, normal for a 5-year-old is 20-30) and decreased level of consciousness
(unarousable). Naloxone (Narcan) is the antidote for morphine and should be
administered immediately to reverse respiratory depression. This is a priority over
other interventions.*
,5. The nurse is admitting a child who has a vaso-occlusive sickle cell crisis. Which
of the following interventions should the nurse anticipate to be prescribed for
the child?
A) Correction of alkalosis and reduction of energy expenditure
B) Globulins and factor VIII replacement
C) Hydration and pain management
D) Electrolyte replacement and administration of heparin
Rationale: The management of a vaso-occlusive crisis focuses on hydration (to
reduce blood viscosity and prevent further sickling) and pain management (usually
with opioids). Oxygen may also be administered. Cold compresses are
contraindicated as they cause vasoconstriction.
6. The nurse working in the emergency department is caring for a child who has
hemophilia and developed a swollen knee after falling off a bicycle. The nurse is
teaching the child's parents about care when similar incidents occur at home in
the future. Which of the following actions should the nurse teach the parents?
A) Take the child to the nearest emergency department
B) Keep the child's affected knee below the level of the heart
C) Apply an ice pack and compression dressings to the knee
D) Administer recommended dose of aspirin
Rationale: The standard intervention for hemarthrosis (bleeding into the joint) is
RICE: Rest, Ice, Compression, and Elevation (above the heart). Ice causes
vasoconstriction to control bleeding. Aspirin is contraindicated due to its anti-
platelet effects.
7. The newly hired nurse is talking with the nurse preceptor about the
prevention of iron-deficiency anemia in infants. Which of the following
statements by the newly hired nurse is correct regarding prevention of this
condition?
A) "Whole cow's milk should not be given until 1 year of age with limited
daily intake."
, B) "Ferrous sulfate drops are contraindicated in infants less than 6 months
of age."
C) "Iron-fortified commercial formula should be given for the first 6 months
of life."
D) "Iron-fortified infant cereal should be introduced to infants at 10
months."
*Rationale: Whole cow's milk is introduced at 1 year but limited to 24 ounces/day
because it is a poor iron source and can lead to "milk anemia." Iron-fortified
formula is recommended, and iron-fortified cereal is introduced around 6
months. Ferrous sulfate drops are used in infants under 6 months when
indicated.*
8. The nurse is assessing a child who has severe iron deficiency anemia. Which
of the following assessment findings should the nurse expect to observe?
A) Pallor
B) Painful swelling of the hands
C) An enlarged abdomen
D) Visual disturbances
Rationale: Pallor is a hallmark sign of severe iron deficiency anemia due to
decreased hemoglobin and reduced oxygen-carrying capacity. Other signs include
fatigue, irritability, tachycardia, and spoon-shaped nails (koilonychia).
9. The nurse is caring for a 4-year-old child who is 36 hours postoperative
following removal of a Wilm's tumor. Which of the following requires
immediate follow-up by the nurse?
A) White blood cell (WBC) count of 15.0 mm³
B) Bowel sounds present in all 4 quadrants
C) Temperature of 100.4°F that occurs one time in a 24-hour period
D) Incision site is pink at the edges
