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NSG 3600 EXAM 4 .
Nursing Practice – Children's Health | 2026 Update | Galen
College of Nursing Comprehensive Review with Complete
Solutions
Welcome, future pediatric nurses! As you prepare for Exam 4, remember that this exam is a
culmination of your pediatric clinical judgment. We are focusing on complex chronic conditions,
the nuanced adolescent population, and high-stakes emergency/ethical situations. Read each
rationales carefully—they are where the true learning happens. You've got this!
PART A: NEUROMUSCULAR, NEURODEVELOPMENTAL & SENSORY DISORDERS
DRILL (Questions 1–10)
1. A 4-year-old child is diagnosed with cerebral palsy (CP). The nurse observes
that the child's muscles are stiff, and the child exhibits a "scissoring" gait when
attempting to walk. The nurse documents this as which type of CP?
A) Dyskinetic
B) Ataxic
C) Spastic
D) Mixed
Answer: C) Spastic
Rationale: Spastic CP is the most common type (70-80% of cases) and is
characterized by hypertonia (stiff muscles), exaggerated deep tendon reflexes,
and a classic scissoring gait due to tight adductor muscles. Dyskinetic involves
slow, writhing movements; ataxic involves poor balance and coordination.
2. A newborn is born with a myelomeningocele. Which nursing intervention is the
absolute priority in the immediate pre-operative period?
A) Administer prophylactic antibiotics IV
B) Place the infant prone with a sterile, moist saline dressing over the sac
C) Measure the head circumference every 4 hours
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D) Initiate latex precautions for all caregivers
Answer: B) Place the infant prone with a sterile, moist saline dressing over the
sac
Rationale: The immediate priority for a myelomeningocele is preventing infection
and trauma to the exposed neural tissue. The infant must be positioned prone or
side-lying to prevent pressure on the sac, covered with a sterile, non-adherent
dressing moistened with warm saline. While latex precautions (D) are mandatory
due to high allergy risk, and head circumference monitoring (C) is important for
hydrocephalus, protecting the exposed sac is the first life-saving/limb-saving
action.
3. A nurse is educating the parents of a 2-month-old infant who just received a
Ventriculoperitoneal (VP) shunt for hydrocephalus. Which statement by the
parent indicates a need for further teaching?
A) "I should lay my baby flat on their back to prevent the fluid from draining too
fast."
B) "If my baby has a high-pitched cry and starts vomiting, I need to call the doctor
immediately."
C) "I will feel along the tube to check for redness or swelling."
D) "I need to watch for a fever, which could mean the shunt is infected."
Answer: A) "I should lay my baby flat on their back to prevent the fluid from
draining too fast."
Rationale: Post-operatively, infants are often positioned flat to prevent rapid CSF
drainage and subdural hematoma. However, long-term at home, the infant should
not be restricted to a flat position; they should be allowed normal positioning.
The other statements are correct: high-pitched cry and vomiting are signs of
increased ICP/shunt malfunction (B); redness/swelling along the tract indicates
infection (C); and fever is a classic sign of shunt infection (D).
4. A 5-year-old boy is being evaluated for Duchenne Muscular Dystrophy (DMD).
The nurse expects which of the following classic assessment findings?
A) Positive Gower's sign and pseudohypertrophy of the calves
B) Ptosis and difficulty swallowing
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C) Winged scapulae and inability to close eyes tightly
D) Flaccid paralysis and absent deep tendon reflexes
Answer: A) Positive Gower's sign and pseudohypertrophy of the calf muscles
Rationale: DMD presents between ages 2-6 years. Gower's sign (using hands to
"climb up" the legs to stand due to proximal muscle weakness) and
pseudohypertrophy of calves (muscle replaced by fat and connective tissue) are
pathognomonic for DMD. Ptosis/swallowing issues are more common in
myasthenia gravis; winged scapulae point to muscular dystrophies like
Facioscapulohumeral, not Duchenne.
5. A nurse is performing an initial assessment on an infant with Down Syndrome
(Trisomy 21). Which associated condition requires the most urgent screening and
intervention shortly after birth?
A) Hypothyroidism
B) Atlantoaxial instability
C) Congenital heart defects (e.g., AV canal)
D) Leukemia
Answer: C) Congenital heart defects (e.g., AV canal)
Rationale: Approximately 40-50% of infants with Down syndrome are born with
congenital heart defects, with complete atrioventricular (AV) canal defect being
the most common. Cardiac complications are the leading cause of death in these
children in the first two years of life, making early echocardiogram and cardiac
stabilization the priority.
6. A toddler is suspected of having Autism Spectrum Disorder (ASD). Which
behavior observed by the nurse is most characteristic of ASD?
A) Intense separation anxiety when the mother leaves the room
B) Lack of eye contact and loss of previously acquired language skills
C) Inability to sit still for more than 5 minutes
D) Fear of strangers that persists beyond 2 years of age
Answer: B) Lack of eye contact and loss of previously acquired language skills
NSG 3600 EXAM 4 .
Nursing Practice – Children's Health | 2026 Update | Galen
College of Nursing Comprehensive Review with Complete
Solutions
Welcome, future pediatric nurses! As you prepare for Exam 4, remember that this exam is a
culmination of your pediatric clinical judgment. We are focusing on complex chronic conditions,
the nuanced adolescent population, and high-stakes emergency/ethical situations. Read each
rationales carefully—they are where the true learning happens. You've got this!
PART A: NEUROMUSCULAR, NEURODEVELOPMENTAL & SENSORY DISORDERS
DRILL (Questions 1–10)
1. A 4-year-old child is diagnosed with cerebral palsy (CP). The nurse observes
that the child's muscles are stiff, and the child exhibits a "scissoring" gait when
attempting to walk. The nurse documents this as which type of CP?
A) Dyskinetic
B) Ataxic
C) Spastic
D) Mixed
Answer: C) Spastic
Rationale: Spastic CP is the most common type (70-80% of cases) and is
characterized by hypertonia (stiff muscles), exaggerated deep tendon reflexes,
and a classic scissoring gait due to tight adductor muscles. Dyskinetic involves
slow, writhing movements; ataxic involves poor balance and coordination.
2. A newborn is born with a myelomeningocele. Which nursing intervention is the
absolute priority in the immediate pre-operative period?
A) Administer prophylactic antibiotics IV
B) Place the infant prone with a sterile, moist saline dressing over the sac
C) Measure the head circumference every 4 hours
,2
D) Initiate latex precautions for all caregivers
Answer: B) Place the infant prone with a sterile, moist saline dressing over the
sac
Rationale: The immediate priority for a myelomeningocele is preventing infection
and trauma to the exposed neural tissue. The infant must be positioned prone or
side-lying to prevent pressure on the sac, covered with a sterile, non-adherent
dressing moistened with warm saline. While latex precautions (D) are mandatory
due to high allergy risk, and head circumference monitoring (C) is important for
hydrocephalus, protecting the exposed sac is the first life-saving/limb-saving
action.
3. A nurse is educating the parents of a 2-month-old infant who just received a
Ventriculoperitoneal (VP) shunt for hydrocephalus. Which statement by the
parent indicates a need for further teaching?
A) "I should lay my baby flat on their back to prevent the fluid from draining too
fast."
B) "If my baby has a high-pitched cry and starts vomiting, I need to call the doctor
immediately."
C) "I will feel along the tube to check for redness or swelling."
D) "I need to watch for a fever, which could mean the shunt is infected."
Answer: A) "I should lay my baby flat on their back to prevent the fluid from
draining too fast."
Rationale: Post-operatively, infants are often positioned flat to prevent rapid CSF
drainage and subdural hematoma. However, long-term at home, the infant should
not be restricted to a flat position; they should be allowed normal positioning.
The other statements are correct: high-pitched cry and vomiting are signs of
increased ICP/shunt malfunction (B); redness/swelling along the tract indicates
infection (C); and fever is a classic sign of shunt infection (D).
4. A 5-year-old boy is being evaluated for Duchenne Muscular Dystrophy (DMD).
The nurse expects which of the following classic assessment findings?
A) Positive Gower's sign and pseudohypertrophy of the calves
B) Ptosis and difficulty swallowing
, 3
C) Winged scapulae and inability to close eyes tightly
D) Flaccid paralysis and absent deep tendon reflexes
Answer: A) Positive Gower's sign and pseudohypertrophy of the calf muscles
Rationale: DMD presents between ages 2-6 years. Gower's sign (using hands to
"climb up" the legs to stand due to proximal muscle weakness) and
pseudohypertrophy of calves (muscle replaced by fat and connective tissue) are
pathognomonic for DMD. Ptosis/swallowing issues are more common in
myasthenia gravis; winged scapulae point to muscular dystrophies like
Facioscapulohumeral, not Duchenne.
5. A nurse is performing an initial assessment on an infant with Down Syndrome
(Trisomy 21). Which associated condition requires the most urgent screening and
intervention shortly after birth?
A) Hypothyroidism
B) Atlantoaxial instability
C) Congenital heart defects (e.g., AV canal)
D) Leukemia
Answer: C) Congenital heart defects (e.g., AV canal)
Rationale: Approximately 40-50% of infants with Down syndrome are born with
congenital heart defects, with complete atrioventricular (AV) canal defect being
the most common. Cardiac complications are the leading cause of death in these
children in the first two years of life, making early echocardiogram and cardiac
stabilization the priority.
6. A toddler is suspected of having Autism Spectrum Disorder (ASD). Which
behavior observed by the nurse is most characteristic of ASD?
A) Intense separation anxiety when the mother leaves the room
B) Lack of eye contact and loss of previously acquired language skills
C) Inability to sit still for more than 5 minutes
D) Fear of strangers that persists beyond 2 years of age
Answer: B) Lack of eye contact and loss of previously acquired language skills
