NSG 3600 Exam 3 Actual Exam V3 | NSG 3600 Nursing Practice –
Children’s Health (NSG3600 Exam 3)
1. A 3-year-old child presents to the emergency department with a sudden onset of high
fever, drooling, and a tripod sitting position. Which nursing action is the absolute priority?
A. Notify the provider and prepare for immediate intubation.
B. Inspect the posterior pharynx using a tongue blade.
C. Obtain a throat culture to identify the causative organism.
D. Administer an intramuscular dose of ceftriaxone.
Answer: A
Rationale: The clinical presentation of drooling, fever, and tripod positioning is highly
suggestive of epiglottitis, a medical emergency. Any attempt to visualize the throat with a
tongue blade can cause immediate laryngospasm and airway obstruction. The priority is to
maintain airway patency, which often requires emergency intubation by a skilled
professional.
2. An infant with Tetralogy of Fallot becomes suddenly cyanotic and agitated during a blood
draw. What is the nurse’s first intervention?
A. Place the infant in a knee-chest position.
B. Administer 100% oxygen via a non-rebreather mask.
C. Prepare a dose of intravenous morphine sulfate.
D. Begin chest compressions immediately.
Answer: A
Rationale: A hypercyanotic spell, or ‘Tet spell,’ is caused by an acute increase in right-to-
left shunting. The knee-chest position increases systemic vascular resistance, which helps
force blood into the pulmonary artery. This simple maneuver is the first-line treatment to
improve oxygenation and stabilize the infant.
3. A nurse is caring for a 4-week-old infant suspected of having hypertrophic pyloric stenosis.
Which assessment finding is most characteristic of this condition?
A. Currant jelly-like stools containing blood and mucus.
B. Bile-stained emesis occurring after every feeding.
C. Projectile vomiting followed by immediate hunger.
D. A sausage-shaped mass in the right upper quadrant.
,Answer: C
Rationale: Pyloric stenosis typically presents between 2 and 8 weeks of age with non-
bilious, projectile vomiting. Despite the vomiting, the infant usually remains hungry and
eager to feed again. A palpable olive-shaped mass in the epigastrium is also a hallmark sign
of the thickened pylorus.
4. Which clinical manifestation would the nurse expect to find in a child diagnosed with acute
glomerulonephritis (AGN)?
A. Massive proteinuria and hypoalbuminemia.
B. Hypotension and polyuria.
C. Periorbital edema and tea-colored urine.
D. Severe jaundice and clay-colored stools.
Answer: C
Rationale: Acute glomerulonephritis often follows a streptococcal infection and presents
with hematuria, which gives the urine a tea-colored appearance. Periorbital edema is a
common early sign due to fluid retention and decreased glomerular filtration.
Hypertension is also a significant concern in AGN, unlike the hypotension seen in shock
states.
5. A 10-year-old child is admitted with a vaso-occlusive sickle cell crisis. What should be the
nurse’s primary focus in the plan of care?
A. Restricting fluids to prevent pulmonary edema.
B. Administering cold compresses to painful joints.
C. Administering oral anticoagulants to prevent clots.
D. Intravenous hydration and aggressive pain management.
Answer: D
Rationale: Hydration is essential to reduce blood viscosity and prevent further sickling of
red blood cells. Vaso-occlusive crises are extremely painful; therefore, appropriate
analgesia, often including opioids, is a priority. Cold compresses should be avoided as they
cause vasoconstriction, which can worsen the crisis.
6. A school-age child is diagnosed with Nephrotic Syndrome. Which dietary modification
should the nurse instruct the parents to follow during a relapse?
A. High-protein, low-calorie diet.
B. Gluten-free, high-fiber diet.
C. High-potassium, high-fat diet.
, D. Low-sodium, fluid-restricted diet.
Answer: D
Rationale: During a relapse of Nephrotic Syndrome, the child experiences significant
edema due to protein loss. Sodium is restricted to help manage fluid retention and
minimize edema. Fluid restriction may also be necessary if the edema is severe or if
hyponatremia is present.
7. The nurse is assessing a 2-year-old with suspected intussusception. Which finding should
be reported to the provider immediately?
A. The child is crying and drawing knees to the chest.
B. A palpable sausage-shaped mass in the abdomen.
C. Passage of a normal brown stool.
D. Vomiting after a feeding.
Answer: C
Rationale: Intussusception occurs when one portion of the bowel telescopes into another.
The passage of a normal brown stool often indicates that the intussusception has
spontaneously reduced itself. This must be reported immediately as it may change the plan
for surgical or radiologic intervention.
8. A nurse is providing discharge teaching to the parents of a child with cystic fibrosis. Which
instruction regarding pancreatic enzymes is correct?
A. Give enzymes once daily in the morning on an empty stomach.
B. Mix the enzymes into a bowl of hot oatmeal.
C. Administer enzymes with every meal and every snack.
D. Omit the enzymes if the child is having a high-fat meal.
Answer: C
Rationale: Pancreatic enzymes are necessary for the digestion and absorption of fats and
proteins in children with cystic fibrosis. They must be taken with all meals and snacks to be
effective. Enzymes should not be mixed with hot foods as heat can deactivate them.
9. A child is brought to the ED after ingesting an unknown quantity of chewable aspirin. What
is the nurse’s priority assessment?
A. Monitor for respiratory alkalosis and metabolic acidosis.
B. Assess for the presence of a ‘cherry-red’ skin color.
C. Check for signs of acute liver failure and jaundice.
D. Evaluate for the presence of a characteristic ‘garlic’ breath odor.
Children’s Health (NSG3600 Exam 3)
1. A 3-year-old child presents to the emergency department with a sudden onset of high
fever, drooling, and a tripod sitting position. Which nursing action is the absolute priority?
A. Notify the provider and prepare for immediate intubation.
B. Inspect the posterior pharynx using a tongue blade.
C. Obtain a throat culture to identify the causative organism.
D. Administer an intramuscular dose of ceftriaxone.
Answer: A
Rationale: The clinical presentation of drooling, fever, and tripod positioning is highly
suggestive of epiglottitis, a medical emergency. Any attempt to visualize the throat with a
tongue blade can cause immediate laryngospasm and airway obstruction. The priority is to
maintain airway patency, which often requires emergency intubation by a skilled
professional.
2. An infant with Tetralogy of Fallot becomes suddenly cyanotic and agitated during a blood
draw. What is the nurse’s first intervention?
A. Place the infant in a knee-chest position.
B. Administer 100% oxygen via a non-rebreather mask.
C. Prepare a dose of intravenous morphine sulfate.
D. Begin chest compressions immediately.
Answer: A
Rationale: A hypercyanotic spell, or ‘Tet spell,’ is caused by an acute increase in right-to-
left shunting. The knee-chest position increases systemic vascular resistance, which helps
force blood into the pulmonary artery. This simple maneuver is the first-line treatment to
improve oxygenation and stabilize the infant.
3. A nurse is caring for a 4-week-old infant suspected of having hypertrophic pyloric stenosis.
Which assessment finding is most characteristic of this condition?
A. Currant jelly-like stools containing blood and mucus.
B. Bile-stained emesis occurring after every feeding.
C. Projectile vomiting followed by immediate hunger.
D. A sausage-shaped mass in the right upper quadrant.
,Answer: C
Rationale: Pyloric stenosis typically presents between 2 and 8 weeks of age with non-
bilious, projectile vomiting. Despite the vomiting, the infant usually remains hungry and
eager to feed again. A palpable olive-shaped mass in the epigastrium is also a hallmark sign
of the thickened pylorus.
4. Which clinical manifestation would the nurse expect to find in a child diagnosed with acute
glomerulonephritis (AGN)?
A. Massive proteinuria and hypoalbuminemia.
B. Hypotension and polyuria.
C. Periorbital edema and tea-colored urine.
D. Severe jaundice and clay-colored stools.
Answer: C
Rationale: Acute glomerulonephritis often follows a streptococcal infection and presents
with hematuria, which gives the urine a tea-colored appearance. Periorbital edema is a
common early sign due to fluid retention and decreased glomerular filtration.
Hypertension is also a significant concern in AGN, unlike the hypotension seen in shock
states.
5. A 10-year-old child is admitted with a vaso-occlusive sickle cell crisis. What should be the
nurse’s primary focus in the plan of care?
A. Restricting fluids to prevent pulmonary edema.
B. Administering cold compresses to painful joints.
C. Administering oral anticoagulants to prevent clots.
D. Intravenous hydration and aggressive pain management.
Answer: D
Rationale: Hydration is essential to reduce blood viscosity and prevent further sickling of
red blood cells. Vaso-occlusive crises are extremely painful; therefore, appropriate
analgesia, often including opioids, is a priority. Cold compresses should be avoided as they
cause vasoconstriction, which can worsen the crisis.
6. A school-age child is diagnosed with Nephrotic Syndrome. Which dietary modification
should the nurse instruct the parents to follow during a relapse?
A. High-protein, low-calorie diet.
B. Gluten-free, high-fiber diet.
C. High-potassium, high-fat diet.
, D. Low-sodium, fluid-restricted diet.
Answer: D
Rationale: During a relapse of Nephrotic Syndrome, the child experiences significant
edema due to protein loss. Sodium is restricted to help manage fluid retention and
minimize edema. Fluid restriction may also be necessary if the edema is severe or if
hyponatremia is present.
7. The nurse is assessing a 2-year-old with suspected intussusception. Which finding should
be reported to the provider immediately?
A. The child is crying and drawing knees to the chest.
B. A palpable sausage-shaped mass in the abdomen.
C. Passage of a normal brown stool.
D. Vomiting after a feeding.
Answer: C
Rationale: Intussusception occurs when one portion of the bowel telescopes into another.
The passage of a normal brown stool often indicates that the intussusception has
spontaneously reduced itself. This must be reported immediately as it may change the plan
for surgical or radiologic intervention.
8. A nurse is providing discharge teaching to the parents of a child with cystic fibrosis. Which
instruction regarding pancreatic enzymes is correct?
A. Give enzymes once daily in the morning on an empty stomach.
B. Mix the enzymes into a bowl of hot oatmeal.
C. Administer enzymes with every meal and every snack.
D. Omit the enzymes if the child is having a high-fat meal.
Answer: C
Rationale: Pancreatic enzymes are necessary for the digestion and absorption of fats and
proteins in children with cystic fibrosis. They must be taken with all meals and snacks to be
effective. Enzymes should not be mixed with hot foods as heat can deactivate them.
9. A child is brought to the ED after ingesting an unknown quantity of chewable aspirin. What
is the nurse’s priority assessment?
A. Monitor for respiratory alkalosis and metabolic acidosis.
B. Assess for the presence of a ‘cherry-red’ skin color.
C. Check for signs of acute liver failure and jaundice.
D. Evaluate for the presence of a characteristic ‘garlic’ breath odor.
