Galen NSG 3600 (NSG3600) Pediatrics – Exam 4 Review | Complete Questions & Answers | Latest 2026–2027.

NSG 3600 Pediatrics Exam 4 – Complete Review Questions & Answers | Galen College of Nursing | Updated 2026–2027 1. Which finding is a core clinical manifestation of attention deficit hyperactivity disorder (ADHD)? A. Painless cervical lymphadenopathy B. Polyuria with weight loss C. Inattention with hyperactivity and impulsivity D. A whitish glow in the pupil 2. Which assessment is included in the diagnostic evaluation for ADHD? A. Bone marrow aspiration B. Orbital ultrasound C. Vision and hearing assessment D. Urine vanillylmandelic acid testing 3. Which medication is listed as a psychostimulant used for ADHD? A. Levothyroxine B. Metformin C. Nystatin D. Methylphenidate 4. According to the notes, how is the prescribed psychostimulant dose for ADHD primarily determined? A. By the child's total burn surface area B. By resolution of symptoms rather than the child's weight C. By the absolute neutrophil count D. By the serum lactic dehydrogenase level 5. Which intervention is part of behavioral therapy for ADHD? A. Routine abdominal palpation B. Limiting all family contact C. Applying a pressure garment D. Parenting skills and prevention of undesired behavior 6. What is the purpose of environmental manipulation for a child with ADHD? A. Eliminate all physical activity B. Modify the environment so the child can be successful C. Prevent the child from interacting with peers D. Replace behavioral therapy with medication only 7. Which chromosomal finding is associated with Down syndrome in the uploaded notes? A. 45 chromosomes with monosomy 21 B. 47 chromosomes, usually trisomy of chromosome 21 C. 46 chromosomes with no chromosomal change D. 48 chromosomes with trisomy of chromosome 18 8. Which finding is consistent with Down syndrome? A. Kussmaul respirations with fruity breath B. Currant-jelly stool C. Hypotonia with a protruding tongue D. Painful swollen long bone after activity 9. Which test is used shortly after birth to diagnose Down syndrome? A. Chromosomal blood test B. Bone scan C. Serum lactic dehydrogenase D. Urine ketone test 10. Which behavior is most consistent with autism spectrum disorder in the notes? A. Persistent painless hematuria B. Excessive bleeding after tooth loss C. Pain that increases with weight bearing D. Impaired communication with restrictive or repetitive behaviors 11. Which nursing approach is especially important for a child with autism spectrum disorder? A. Frequently change routines to increase adaptability B. Use rectal temperatures for accuracy C. Maintain a consistent routine and respect physical boundaries D. Place medications in the child's full bottle 12. What is the nurse's responsibility when child maltreatment is suspected? A. Report suspected abuse according to local and agency guidelines B. Wait for the child to confirm the abuse in writing C. Discuss the concern only with other families D. Delay reporting until physical injury is severe 13. Type 1 diabetes mellitus in children is described as which process? A. Resistance to insulin with no pancreatic cell destruction B. A fungal infection of the pancreas C. An autoimmune disease that destroys pancreatic insulin-producing cells D. Overactivity of the pituitary gland 14. Which cluster is most characteristic of type 1 diabetes mellitus? A. Fever, night sweats, and lymphadenopathy B. Bruising, hemarthrosis, and epistaxis C. Polyuria, polydipsia, polyphagia, and weight loss D. Pruritic vesicles with crusting 15. Which tests are listed for diagnosing diabetes mellitus in the Exam 4 notes? A. PT and PTT B. Blood glucose and hemoglobin A1C C. CBC and reticulocyte count only D. Orbital ultrasound and MRI 16. Which insulin is listed as rapid acting? A. Humalog or Novolog B. Regular C. NPH D. Lantus 17. Which finding is associated with hypoglycemia in the notes? A. Fruity breath with Kussmaul respirations B. Dry flushed skin with thirst C. Painless firm lymph nodes D. Sweating with shakiness and hunger 18. Which finding is associated with hyperglycemia? A. Deep rapid Kussmaul respirations and fruity acetone breath B. Pearlescent eggs on the hair shaft C. Hemarthrosis of the knee D. A simian crease 19. Diabetic ketoacidosis (DKA) results from which problem? A. Excess factor VIII activity B. Severely deficient insulin causing acidosis C. Excess thyroid hormone production D. A bacterial skin infection 20. Which blood glucose value supports the diagnosis of DKA in the uploaded notes? A. Less than 18 mg/dL B. Greater than 500 units/L C. Less than 1,000/mcL D. Greater than 250 mg/dL 21. Which laboratory finding is expected with DKA? A. A negative urine ketone test B. Ketonuria C. An ANC above 1,500/mcL D. Reed-Sternberg cells 22. Which treatment combination is emphasized for DKA? A. Fluids, electrolyte replacement, and insulin B. Radiation, enucleation, and eye irrigation C. Factor replacement and DDAVP only D. Topical antibiotics and dressing changes only 23. Which monitoring is specifically emphasized during DKA treatment? A. Daily hair-shaft inspection B. Respiratory and neurologic assessment C. Abdominal palpation every hour D. Weekly lymph node biopsy 24. How often is blood glucose monitored during DKA treatment according to the notes? A. Every 2 to 4 months B. Every 7 to 10 days C. Hourly D. Once after treatment is completed 25. Type 2 diabetes mellitus is primarily described as which problem? A. Complete absence of factor IX B. Failure to produce thyroid hormone only at birth C. Resistance to recognizing and using insulin D. A malignant increase in leukocytes 26. Which presentation is consistent with type 2 diabetes in children? A. Obesity and fatigue, with some children having no symptoms B. Only severe bleeding into joints C. Only a painless abdominal mass D. Only a whitish glow in the pupil 27. Which oral hypoglycemic medication is listed for type 2 diabetes? A. Levothyroxine B. Nystatin C. Metformin D. Dactinomycin 28. Which measure is emphasized for prevention and management of type 2 diabetes? A. Avoiding all carbohydrates B. Avoiding all fluids during illness C. Healthy diet, physical activity, and a healthy weight D. Restricting all exercise 29. Phenylketonuria (PKU) is described as which type of disorder? A. An X-linked bleeding disorder B. An autosomal recessive inherited error of metabolism C. A bacterial skin infection D. A malignant retinal tumor 30. How is PKU diagnosed in the notes? A. Chest radiograph B. Bone marrow aspiration C. Wood's lamp examination D. Metabolic newborn screening 31. Which diet is listed for PKU? A. A high-cow's-milk diet B. An unrestricted high-protein diet C. A diet limited to greasy foods D. A phenylalanine-free diet 32. Which laboratory pattern is listed for hypothyroidism? A. High T4 with low TSH B. Low hemoglobin with high reticulocytes C. Low T4 with high TSH D. High LDH with Reed-Sternberg cells 33. Which treatment is used for pediatric hypothyroidism in the notes? A. Metformin B. Levothyroxine replacement C. Methylphenidate D. Vincristine 34. Precocious puberty in the notes is associated with which mechanism? A. Deficiency of factor VIII B. Autoimmune destruction of pancreatic cells C. Overactivity of the pituitary gland, sometimes related to CNS lesions or injury D. Candida albicans infection 35. Which treatment is listed for precocious puberty? A. Gonadotropin-releasing hormone therapy B. Permethrin cream rinse C. Recombinant factor VIII only D. Intrathecal chemotherapy 36. Which teaching point is included for precocious puberty? A. Address body-image concerns and follow the child's chronological age B. Treat the child according to physical appearance rather than age C. Avoid all follow-up growth measurements D. Place medications in a full bottle 37. Which statement about atopic dermatitis (eczema) is supported by the notes? A. It is caused by Candida albicans B. It is a malignant skin disorder C. It is caused by factor VIII deficiency D. It is not contagious and is associated with allergies and asthma 38. Which home-care instruction is appropriate for eczema? A. Scrub the rash vigorously with hot water B. Keep the skin dry and avoid moisturizers C. Apply ice directly for long periods D. Use a lukewarm bath without harsh soaps and apply emollient lotion 39. Impetigo contagiosa is described as which type of infection? A. A fungal infection caused by Candida B. A metabolic disorder C. A highly contagious bacterial infection D. A chromosomal abnormality 40. Which lesion is characteristic of impetigo? A. A painless firm abdominal mass B. Vesicles or pustules that dry to a crusty, sticky residue C. A whitish pupil reflex D. A deep partial-thickness burn 41. When may a child with impetigo return after antibiotics are started, according to the notes? A. After 2 to 4 hours B. After 3 weeks C. After 24 hours D. Only after 6 months 42. Cutaneous candidiasis is caused by which organism? A. Staphylococcus aureus B. Propionibacterium acnes C. A sickled red blood cell D. Candida albicans 43. Which oral finding is associated with candidiasis? A. A red reflex in both eyes B. Painless cervical nodes C. A sunburst bone pattern D. Whitish-gray plaques that cannot be removed 44. Which teaching helps prevent oral candidiasis in a child using a corticosteroid inhaler? A. Rinse the mouth after using the inhaler B. Avoid all oral hygiene C. Share utensils to build immunity D. Apply pressure garments 45. Which description matches tinea corporis? A. Round to oval lesions with a border and central clearing B. Scaly pruritic patches only on the scalp with hair loss C. Red scaly skin only between the toes D. A painless unilateral abdominal mass 46. Which prevention measure is appropriate for tinea? A. Share sports headgear between children B. Avoid handwashing C. Do not share towels, combs, hats, or helmets D. Keep damp socks on the feet 47. What treatment duration is listed for antifungal therapy for tinea? A. 15 minutes B. 24 hours C. 2 to 4 hours D. At least 6 weeks 48. Contact dermatitis occurs when which event happens? A. A child inherits an X-linked factor deficiency B. Pancreatic cells are destroyed C. A malignant tumor develops in the retina D. An allergen or irritant directly contacts the skin 49. Which finding is consistent with contact dermatitis? A. An irritated, inflamed, pruritic rash with possible vesicles or bullae B. Painless supraclavicular lymph nodes C. A hard abdominal mass that crosses the midline D. Petechiae from marrow suppression 50. Which treatment is listed for pediculosis capitis? A. Intrathecal chemotherapy B. Factor replacement C. Pediculicide application plus manual nit removal D. Levothyroxine 51. Which reaction to a bee or wasp sting suggests an allergic response? A. Only a simian crease B. Only painless hematuria C. Hives, flushing, angioedema, and wheezing D. Only a low reticulocyte count 52. Which type of burn is most common in children according to the notes? A. Radiation burn B. Thermal burn C. Chemical burn D. Electrical burn 53. Which finding describes a superficial burn? A. White tissue with huge blisters and healing over 3 to 9 weeks B. Total destruction requiring assessment by Rule of Nines C. A crusty sticky bacterial exudate D. Erythema and pain with intact epidermis and no blisters 54. Which finding suggests an inhalation injury? A. A simian crease B. A painless firm cervical node C. Singed nasal hairs, stridor, hoarseness, or burns around the mouth D. A round lesion with central clearing 55. What is the priority treatment for a chemical burn? A. Neutralize it with a second chemical B. Remove or dilute/brush off the chemical and do not use another chemical C. Apply ice directly to the burn D. Delay removal until a biopsy is completed 56. Which statement best describes anemia in childhood? A. Increased platelets reduce clotting B. Increased neutrophils cause hypoxia C. Excess thyroid hormone lowers oxygen delivery D. Decreased circulating red blood cells reduce the oxygen-carrying capacity of blood 57. Iron deficiency anemia is described as which type of anemia? A. Microcytic, hypochromic anemia caused by inadequate iron B. Macrocytic anemia caused by excess iron C. Hemolytic anemia caused by excess factor VIII D. Anemia caused by excess thyroid hormone 58. Which infant is identified as being at increased risk for iron deficiency anemia? A. An infant with head lice B. An infant with tinea pedis C. A premature infant D. An infant with a superficial burn 59. Which feeding practice increases the risk for iron deficiency anemia? A. Iron-fortified cereal from 6 to 12 months B. Prolonged bottle feeding and excessive cow's milk intake C. Breast milk or iron-fortified formula for the first year D. Offering iron-rich foods 60. Which finding is consistent with iron deficiency anemia? A. Kussmaul respirations with ketonuria B. Pallor, fatigue, tachycardia, and delayed motor development C. Painless cervical lymphadenopathy D. A white pupil reflex 61. Which food is listed as iron rich? A. Greasy fried food B. Only cow's milk C. Only clear liquids D. Beans 62. What oral iron dose is listed in the oncology notes for iron deficiency anemia? A. 250 mg/kg every hour B. 18 mg/kg every 4 hours C. 500 mg once per month D. 3 mg/kg per day in 1 to 2 doses 63. Which feeding instruction helps prevent iron deficiency anemia? A. Start cow's milk as the main drink before 6 months B. Do not give cow's milk before 12 months of age C. Stop iron-fortified formula as early as possible D. Avoid iron-fortified cereal 64. How is sickle cell disease inherited according to the notes? A. Autosomal dominant B. Autosomal recessive C. X-linked dominant D. Mitochondrial only 65. Which manifestation is most directly related to vaso-occlusion in sickle cell disease? A. Pain B. A whitish pupil reflex C. Scalp hair loss D. A crusty impetigo lesion 66. Which laboratory pattern is listed for sickle cell disease? A. High hemoglobin with a low reticulocyte count B. Low hemoglobin/hematocrit with a high reticulocyte count C. Low T4 with high TSH D. High LDH with Reed-Sternberg cells 67. Which test is listed for diagnosing sickle cell disease? A. Wood's lamp examination B. Lymph node biopsy for Reed-Sternberg cells C. Orbital ultrasound only D. Hemoglobin electrophoresis 68. Which nursing priorities are emphasized during a sickle cell crisis? A. Fluid restriction and vigorous exercise B. Routine abdominal palpation C. Avoiding all analgesics D. Rest, hydration, pain control, and adequate oxygenation 69. When is supplemental oxygen indicated in the sickle cell notes? A. When oxygen saturation is below 90% B. When oxygen saturation is above 99% C. Only after a skin biopsy D. Only after a normal CBC 70. Which statement about ketorolac for sickle cell pain is in the notes? A. It should not exceed 5 days B. It must be given for at least 6 weeks C. It is used only for head lice D. It replaces hydration 71. Which factor can precipitate a sickle cell crisis? A. Adequate hydration and rest B. Quiet activities C. Iron-fortified cereal D. Dehydration from strenuous physical activity 72. Why are some children with sickle cell disease given prophylactic penicillin? A. To increase factor VIII B. To help prevent overwhelming sepsis C. To treat tinea corporis D. To lower TSH 73. What should a child with a mild sickle cell crisis be taught to do? A. Continue strenuous exercise B. Stop activity, rest, drink fluids, and take prescribed medication C. Restrict fluids D. Ignore pain until it resolves 74. Which description matches a vaso-occlusive sickle cell crisis? A. Pooling of blood in the spleen with shock B. Reduced RBC production after a viral illness C. Microcirculatory clotting causing distal ischemia and infarction D. Lower oxygen in the blood with pneumonia-like symptoms 75. Which description matches an aplastic sickle cell crisis? A. Decreased production and increased destruction of RBCs, often associated with viral infection B. Pooling of blood in an enlarged spleen C. Chest pain with wheezing and hypoxia D. Pain caused only by trauma to a joint 76. Which sickle cell crisis is described as life threatening because large amounts of blood pool in the spleen? A. Splenic sequestration crisis B. Vaso-occlusive crisis C. Aplastic crisis D. Acute chest syndrome 77. Which findings are associated with acute chest syndrome? A. Painless hematuria and hypertension B. Chest pain, fever, cough, tachypnea, wheezing, and hypoxia C. Scalp itching and hair loss D. Painless cervical lymphadenopathy only 78. Hemophilia A is caused by deficiency or absence of which clotting factor? A. Factor IX B. Factor VIII C. Factor VII only D. Factor I 79. How is hemophilia described as being inherited in the notes? A. Sex-linked recessive, with mothers as carriers and sons affected B. Autosomal dominant in all daughters C. Mitochondrial inheritance D. Autosomal recessive requiring two sickle genes 80. Which finding is characteristic of hemophilia? A. A whitish pupil reflex B. Prolonged or excessive bleeding after injury or tooth loss C. Deep rapid Kussmaul respirations D. A round lesion with central clearing 81. What does hemarthrosis mean in the hemophilia notes? A. Bleeding into the retina B. A skin infection around the mouth C. A tumor in the metaphysis D. Bleeding into a joint causing swelling, stiffness, or pain 82. Which test is described as the most important test for hemophilia A or B? A. Urine ketone testing B. Wood's lamp examination C. Serum TSH alone D. Direct assay of plasma factor activity 83. Which activity or medication should be avoided in a child with hemophilia? A. Quiet play and protective equipment B. Factor replacement therapy C. Aspirin and contact sports D. Seat-belt use 84. Which safety measure is recommended for a child with hemophilia? A. Encourage trampoline use B. Use bunk beds whenever possible C. Use helmets, car seats, and seat belts D. Use intramuscular injections for convenience 85. Which treatment is used to replace the missing clotting factor in hemophilia? A. Metformin B. Recombinant factor products C. Levothyroxine D. Permethrin 86. Which ANC value is considered neutropenia in an infant according to the notes? A. Less than 1,000/mcL B. Greater than 1,500/mcL C. Greater than 500 units/L D. Less than 18 mEq/L 87. Which finding is commonly associated with neutropenia? A. A white pupil reflex B. A simian crease C. Fever D. Projectile vomiting 88. Which study is included in the diagnostic evaluation of neutropenia? A. CBC with differential and peripheral smear B. Only a Wood's lamp exam C. Only a chest x-ray D. Only hemoglobin electrophoresis 89. What does "nadir" refer to in a child receiving immunosuppressive therapy? A. The time of the lowest blood counts B. The time of highest blood glucose C. The time of greatest burn depth D. The time of highest thyroid hormone 90. Which temperature-related instruction is given for a neutropenic child? A. Use rectal temperatures because they are preferred B. Ignore fever if the child feels well C. Check temperature only once per month D. Seek medical attention for fever around 101.5°F and do not take rectal temperatures 91. Which exposure should a neutropenic child avoid? A. Quiet activities B. Fresh flowers/plants and people who are sick or recently received a live vaccine C. Prescribed oral hygiene D. A private room 92. Which medication is listed as a granulocyte colony-stimulating factor for severe neutropenia? A. Neupogen B. Lantus C. Nystatin D. Permethrin 93. What is required before a child receives a blood transfusion? A. Only a urine ketone test B. Only a Wood's lamp exam C. Routine abdominal palpation D. Consent and verification using two patient identifiers 94. What timing rule is listed for hanging blood? A. Hang after 6 weeks and complete in 24 hours B. Hang within 3 weeks and complete in 7 days C. Hang within 30 minutes and complete within 4 hours D. Hang only after the child eats 95. What is the first action if a transfusion reaction is suspected? A. Increase the infusion rate B. Stop the transfusion C. Add medication to the blood bag D. Continue the transfusion until the provider arrives 96. Which blood product is listed for anemia? A. Platelets B. Fresh frozen plasma C. Factor IX only D. Packed red blood cells (PRBCs) 97. What is the primary treatment for many pediatric cancers according to the notes? A. Chemotherapy B. Permethrin C. Levothyroxine D. Topical hydrocortisone only 98. Which adverse effect is listed for chemotherapy? A. Trisomy 21 B. A simian crease C. Hyperflexible joints D. Alopecia 99. Which adverse effect is listed for radiation therapy? A. Hemarthrosis B. Skin desquamation and mucous membrane irritation C. Acanthosis nigricans D. Pica 100. Which nutritional plan is recommended for a child with cancer who has poor intake? A. Small frequent meals with appealing textures and food choices B. Large greasy meals three times daily C. Only cow's milk D. No calories during chemotherapy 101. What is the priority nursing action related to infection in a child with cancer? A. Encourage exposure to crowds B. Allow fresh flowers in the room C. Prevent infection using neutropenic precautions and meticulous care D. Use rectal temperatures frequently 102. Which psychosocial intervention is appropriate for a child with cancer? A. Be present, listen, and involve family and child-life resources B. Discourage family visits C. Avoid play or age-appropriate activities D. Withhold information from all children 103. Which statement about acute lymphocytic leukemia (ALL) is correct? A. It is a fungal infection of the skin B. It is a tumor that begins in the retina C. It is the most common type of cancer in children and peaks around ages 2 to 5 D. It is limited to the middle of long bones 104. Which finding may occur with ALL? A. Fever, fatigue, pallor, petechiae, and bone or joint pain B. Only itchy scalp lesions C. Only polyuria and thirst D. Only a painless eye finding 105. Which test is required to make the diagnosis of ALL? A. Wood's lamp examination B. Urine ketone test C. Skin biopsy for contact dermatitis D. Bone marrow aspiration 106. Why is a lumbar puncture performed in a child with ALL? A. To diagnose tinea capitis B. To assess for CNS disease and assist with staging C. To evaluate a superficial burn D. To confirm Down syndrome 107. What is the purpose of a chest radiograph in the ALL workup? A. To diagnose PKU B. To confirm hemophilia A C. To detect a mediastinal mass D. To identify lice eggs 108. Which finding is associated with the best prognosis in ALL according to the oncology notes? A. ANC less than 1,000/mcL in an infant B. LDH greater than 500 units/L C. Blood glucose greater than 250 mg/dL D. WBC less than 5,000/mm in a child age 2 to 9 109. Which sequence lists the three phases of chemotherapy for ALL in the oncology notes? A. Burn, recovery, and rehabilitation B. Rapid, short, and long acting C. Superficial, partial, and full thickness D. Remission-induction, consolidation, and maintenance 110. What may happen if ALL treatment is stopped prematurely? A. The child immediately develops tinea B. All blood counts permanently normalize C. Relapse may occur within a few months D. The disease becomes limited to the skin 111. When is bone marrow transplantation mentioned for ALL? A. For uncomplicated eczema B. For type 2 diabetes C. For children in a second remission after relapse D. For head lice 112. Which safety teaching is appropriate for a child with ALL and low blood counts? A. Participate in contact sports B. Avoid falls, monitor for petechiae, and stay away from ill people and crowds C. Use rectal temperatures D. Share drinking glasses 113. Which statement about acute myelogenous leukemia (AML) is supported by the notes? A. It is the most common retinal tumor B. It is limited to lymph nodes near the body surface C. It is the second most common leukemia seen in children and can affect all three blood cell types D. It is caused by iron deficiency 114. Which manifestation is associated with AML in the notes? A. Flu-like symptoms with pallor, bruising, bleeding, fever, or blueberry-muffin lesions B. Only a scaly ring on the skin C. Only thirst and polyuria D. Only a painless unilateral kidney mass 115. Which diagnostic test is listed for AML? A. Wood's lamp examination B. Hemoglobin A1C only C. Bone marrow aspiration D. Urine VMA only 116. Which treatment is emphasized for AML? A. Topical antifungal therapy B. Diet alone C. Eye enucleation D. Aggressive multi-agent chemotherapy with induction treatment 117. Where does osteosarcoma usually occur? A. Only in the retina B. In the metaphysis, the growing portion of a long bone C. Only in lymph nodes D. Only in the adrenal gland 118. Which sequence reflects common osteosarcoma sites in the notes? A. Femur, then tibia, then humerus B. Retina, spleen, then pancreas C. Scalp, groin, then feet D. Kidney, thyroid, then pancreas 119. Which presentation is characteristic of osteosarcoma? A. Painless cervical lymphadenopathy B. Oral plaques that cannot be removed C. Polyuria with weight loss D. Pain and swelling that worsen with activity, often with a limp 120. Which imaging study is used to evaluate possible lung metastasis in osteosarcoma? A. Chest x-ray B. Wood's lamp C. Orbital ultrasound D. Chromosomal blood test 121. What provides final confirmation of osteosarcoma? A. CBC alone B. Biopsy with microscopic examination C. Urine ketones D. Physical examination alone 122. Which treatment sequence is described for osteosarcoma? A. Chemotherapy to shrink the tumor followed by surgical resection B. Radiation only with no surgery C. Topical antibiotics followed by emollients D. Levothyroxine followed by metformin 123. Which nursing concern is important after surgical treatment for osteosarcoma? A. Body image, mobility, pain, and infection monitoring B. Avoiding all family contact C. Encouraging high-risk sports D. Routine rectal temperatures 124. Which statement best describes Ewing sarcoma? A. A retinal tumor found only in infants B. A highly malignant tumor involving bone and soft tissue, often in children ages 10 to 20 C. A kidney tumor that never involves bone D. A fungal infection of the scalp 125. Which finding may occur when Ewing sarcoma involves the chest wall? A. A cat-eye reflex B. Respiratory distress C. Polyphagia D. Hemarthrosis 126. Which diagnostic and treatment plan is listed for Ewing sarcoma? A. Wood's lamp and topical antibiotics B. TSH testing and levothyroxine C. Urine ketones and metformin only D. Biopsy with CT/MRI/bone scan, multi-agent chemotherapy, and surgical resection if possible 127. Which finding helps distinguish neuroblastoma from Wilms tumor in the notes? A. A neuroblastoma mass is always limited to one kidney B. A neuroblastoma mass may cross the midline C. A neuroblastoma mass must never be imaged D. A neuroblastoma mass is always painful 128. Where does neuroblastoma most commonly develop? A. In the abdomen within adrenal-gland tissue B. In the retina only C. In the thyroid gland D. In the scalp only 129. Which finding may occur when neuroblastoma spreads to the skull and orbit? A. A simian crease B. Swelling and bruising around the eyes C. A crusty scalp lesion D. A swollen knee from hemarthrosis 130. What is required for a clear diagnosis of neuroblastoma? A. Urine ketones alone B. A skin assessment only C. Biopsy D. PT and PTT only 131. Which urine tests are listed in the neuroblastoma workup? A. TSH and T4 B. PT and PTT C. Vanillylmandelic acid and homovanillic acid D. Hemoglobin and hematocrit only 132. Which statement describes Wilms tumor? A. A nephroblastoma arising in one or both kidneys, commonly diagnosed at ages 2 to 5 B. A retinal tumor of adolescence C. A fungal infection of the groin D. A chromosomal disorder 133. Which assessment finding is typical of Wilms tumor? A. A hard abdominal mass that routinely crosses the midline B. A painless unilateral abdominal mass that usually does not cross the midline C. Only joint swelling D. Only a whitish pupil 134. What is the critical nursing precaution after Wilms tumor is diagnosed? A. Palpate the mass each shift B. Do not palpate the abdomen C. Massage the abdomen before meals D. Apply pressure over the mass 135. After surgery for Wilms tumor, which assessment is important? A. Avoid measuring urine output B. Use only eye-socket irrigation C. Monitor the remaining kidney through urine output, urine characteristics, pain, and lab values D. Check hair shafts for nits 136. Which finding is most characteristic of retinoblastoma? A. A whitish glow in the pupil, or leukocoria/cat-eye reflex B. Painless cervical lymphadenopathy C. Currant-jelly stool D. A sunburst pattern in a long bone 137. Which treatment may be used when a retinoblastoma eye has no potential for useful vision? A. Factor VIII replacement B. Pyloromyotomy C. Primary enucleation D. Metformin 138. After retinoblastoma enucleation, when is the child typically fitted for a prosthetic eye? A. After 15 minutes B. After 2 to 4 hours C. After 6 to 12 months only D. After about 3 weeks 139. Which finding is most characteristic of Hodgkin lymphoma? A. A midline-crossing adrenal mass B. A whitish-gray oral plaque C. Kussmaul respirations D. Painless, firm cervical or supraclavicular lymphadenopathy 140. What confirms the diagnosis of Hodgkin lymphoma? A. Urine ketones B. Biopsy showing Reed-Sternberg cells C. Wood's lamp examination D. Hemoglobin electrophoresis 141. Which statement describes non-Hodgkin lymphoma in the notes? A. It is always localized and slow growing B. It affects only the retina C. It is caused by iron deficiency D. It has rapid onset with widespread involvement and may have LDH above 500 units/L 142. Which treatment is emphasized for non-Hodgkin lymphoma? A. Aggressive multi-agent chemotherapy started as soon as possible, with intrathecal chemotherapy for CNS prophylaxis B. Topical antibiotics only C. Levothyroxine only D. Permethrin rinse 143. What comfort measure is appropriate for a dying infant? A. Rocking, touch, non-nutritive sucking, and familiar people or security objects B. Detailed explanations of decomposition C. Frequent separation from caregivers D. Removing all familiar objects 144. How does a toddler commonly view death according to the notes? A. As fully final and biologically understood B. As a laboratory value C. As a skin infection D. As reversible and often as separation or disruption of routine 145. How should a nurse explain death to a preschool child? A. Use abstract euphemisms and long explanations B. Tell the child illness is punishment for bad behavior C. Use short, simple, honest answers and avoid describing death as going to sleep D. Avoid answering any questions 146. Which approach is appropriate for a school-age child facing death? A. Exclude the child from all discussions B. Assume the child believes death is reversible C. Avoid discussing fears of abandonment or body changes D. Include the child in discussions and do not shield the child from the truth 147. Which approach is appropriate for an adolescent facing death? A. Include the adolescent in decision making and allow discussion of unrealized goals and feelings B. Treat the adolescent as unable to understand death C. Prevent the adolescent from saying goodbye D. Avoid all discussion of independence 148. Which finding is listed as a sign of impending death? A. Increasing appetite and stronger pulse B. Persistent warm flushed extremities with rising blood pressure C. Cheyne-Stokes respirations with periods of apnea D. Increasing bowel and bladder control 149. Which additional change is expected as death approaches? A. Increasing urine output and stronger circulation B. Cool pale-to-cyanotic skin with decreasing pulse and blood pressure C. Progressively warmer extremities D. Improving appetite and activity 150. Which statement should the nurse avoid when supporting parents after the death of a child? A. I know exactly how you feel B. Your child will be missed C. Being quietly present D. Using appropriate touch