NSG 434 Exam 3 Study Guide 2026 | Nursing
Care of Children | Practice Questions with
Correct Answers & Detailed Rationales | GCU
Pediatric Nursing Review
Question 1
A 4-year-old child is diagnosed with Acute Lymphoblastic Leukemia (ALL). Which
laboratory result should the nurse prioritize as the most significant risk for infection?
A) Platelet count of 150,000/mm³
B) Hemoglobin level of 10 g/dL
C) Absolute Neutrophil Count (ANC) of 450/mm³
D) White blood cell count of 12,000/mm³
Correct Answer: C
Rationale: An ANC below 500/mm³ indicates severe neutropenia and a high risk for
life-threatening infection. In pediatric oncology, monitoring the ANC is critical for
determining the safety of administering chemotherapy and the need for protective
isolation. The other values are within or near normal ranges and do not represent the
same level of acute risk as the low ANC.
Question 2
The nurse is caring for a 6-year-old child admitted with a vaso-occlusive sickle cell
crisis. Which nursing intervention is the highest priority?
A) Starting intravenous fluids for hydration
B) Administering oxygen via nasal cannula
C) Administering meperidine for pain management
D) Providing a high-protein diet
Correct Answer: A
,Rationale: Hydration is the priority intervention during a vaso-occlusive crisis to
reduce blood viscosity and prevent further sickling. While oxygen and pain
management are important, increasing fluid volume helps mobilize the sickled cells
that are obstructing blood flow. Meperidine should be avoided in children due to the
risk of seizures associated with its metabolite.
Question 3
A toddler is suspected of having leukemia. Which diagnostic test is considered the
definitive method to confirm a diagnosis of Acute Lymphoblastic Leukemia (ALL)?
A) Complete blood count (CBC) with differential
B) Lumbar puncture
C) Bone marrow aspiration and biopsy
D) Chest X-ray
Correct Answer: C
Rationale: A bone marrow aspiration and biopsy is the definitive test used to identify
the type and percentage of abnormal white blood cells. A CBC may show suspicious
findings like anemia or thrombocytopenia, but it cannot confirm the specific type of
leukemia. Lumbar punctures are performed later to determine if the central nervous
system has been involved.
Question 4
A nurse is teaching the parents of a child with hemophilia A about injury prevention.
Which statement by the parents indicates understanding?
A) "We should give ibuprofen for pain."
B) "We should avoid contact sports."
C) "We should encourage rough play to build strength."
D) "We should use aspirin for headaches."
Correct Answer: B
Rationale: Children with hemophilia should avoid contact sports and activities that
increase bleeding risk. Ibuprofen and aspirin both interfere with platelet function and
should be avoided; acetaminophen is the preferred analgesic. Rough play increases
,the risk of bleeding episodes. Factor replacement therapy is the primary treatment for
bleeding episodes.
Question 5
A child with sickle cell disease presents with pallor, tachycardia, and splenic
sequestration. Which finding is most concerning?
A) Hemoglobin of 10 g/dL
B) Sudden drop in hemoglobin to 5 g/dL with left upper quadrant pain
C) Mild jaundice
D) Pain in the hands and feet
Correct Answer: B
Rationale: Splenic sequestration crisis is a life-threatening complication of sickle cell
disease characterized by rapid pooling of blood in the spleen, causing sudden severe
anemia, hypovolemia, and shock. A sudden drop in hemoglobin with left upper
quadrant pain requires immediate intervention, including IV fluids and possible
transfusion. Mild jaundice and hand-foot syndrome are common but less acutely
dangerous.
Question 6
A nurse is caring for a child receiving chemotherapy. Which laboratory value
indicates the need for neutropenic precautions?
A) Platelet count 200,000/mm³
B) ANC 400/mm³
C) Hemoglobin 11 g/dL
D) WBC 8,000/mm³
Correct Answer: B
Rationale: An ANC below 500/mm³ requires neutropenic precautions, including a
private room, strict hand hygiene, and avoidance of fresh flowers, raw fruits, and
vegetables. Platelet count, hemoglobin, and total WBC within normal limits do not
require these precautions.
, Question 7
A child with a brain tumor is receiving dexamethasone. Which adverse effect should
the nurse monitor?
A) Hypoglycemia
B) Weight loss
C) Hyperglycemia and increased appetite
D) Bradycardia
Correct Answer: C
Rationale: Dexamethasone is a corticosteroid commonly used to reduce cerebral
edema in children with brain tumors. Adverse effects include hyperglycemia,
increased appetite, weight gain, mood changes, and immunosuppression.
Hypoglycemia and weight loss are not typical. Bradycardia is not a common effect.
Question 8
A nurse is assessing a child with suspected Wilms tumor. Which nursing intervention
is the most important?
A) Avoid any further palpation of the abdomen
B) Palpate deeply to determine the size of the mass
C) Check for rebound tenderness in the lower quadrants
D) Palpate only when the child is in a prone position
Correct Answer: A
Rationale: Wilms tumor (nephroblastoma) is an encapsulated tumor of the kidney.
Vigorous or even routine palpation of the abdomen can cause the capsule to rupture,
leading to the seeding of cancer cells throughout the peritoneal cavity. Nursing care
must focus on placing a "Do Not Palpate" sign at the bedside.
Question 9
A child with ALL is receiving intrathecal methotrexate. Which position should the
nurse place the child in after the procedure?
A) Supine for 1 hour
B) Flat, lying on the side for 1 hour
Care of Children | Practice Questions with
Correct Answers & Detailed Rationales | GCU
Pediatric Nursing Review
Question 1
A 4-year-old child is diagnosed with Acute Lymphoblastic Leukemia (ALL). Which
laboratory result should the nurse prioritize as the most significant risk for infection?
A) Platelet count of 150,000/mm³
B) Hemoglobin level of 10 g/dL
C) Absolute Neutrophil Count (ANC) of 450/mm³
D) White blood cell count of 12,000/mm³
Correct Answer: C
Rationale: An ANC below 500/mm³ indicates severe neutropenia and a high risk for
life-threatening infection. In pediatric oncology, monitoring the ANC is critical for
determining the safety of administering chemotherapy and the need for protective
isolation. The other values are within or near normal ranges and do not represent the
same level of acute risk as the low ANC.
Question 2
The nurse is caring for a 6-year-old child admitted with a vaso-occlusive sickle cell
crisis. Which nursing intervention is the highest priority?
A) Starting intravenous fluids for hydration
B) Administering oxygen via nasal cannula
C) Administering meperidine for pain management
D) Providing a high-protein diet
Correct Answer: A
,Rationale: Hydration is the priority intervention during a vaso-occlusive crisis to
reduce blood viscosity and prevent further sickling. While oxygen and pain
management are important, increasing fluid volume helps mobilize the sickled cells
that are obstructing blood flow. Meperidine should be avoided in children due to the
risk of seizures associated with its metabolite.
Question 3
A toddler is suspected of having leukemia. Which diagnostic test is considered the
definitive method to confirm a diagnosis of Acute Lymphoblastic Leukemia (ALL)?
A) Complete blood count (CBC) with differential
B) Lumbar puncture
C) Bone marrow aspiration and biopsy
D) Chest X-ray
Correct Answer: C
Rationale: A bone marrow aspiration and biopsy is the definitive test used to identify
the type and percentage of abnormal white blood cells. A CBC may show suspicious
findings like anemia or thrombocytopenia, but it cannot confirm the specific type of
leukemia. Lumbar punctures are performed later to determine if the central nervous
system has been involved.
Question 4
A nurse is teaching the parents of a child with hemophilia A about injury prevention.
Which statement by the parents indicates understanding?
A) "We should give ibuprofen for pain."
B) "We should avoid contact sports."
C) "We should encourage rough play to build strength."
D) "We should use aspirin for headaches."
Correct Answer: B
Rationale: Children with hemophilia should avoid contact sports and activities that
increase bleeding risk. Ibuprofen and aspirin both interfere with platelet function and
should be avoided; acetaminophen is the preferred analgesic. Rough play increases
,the risk of bleeding episodes. Factor replacement therapy is the primary treatment for
bleeding episodes.
Question 5
A child with sickle cell disease presents with pallor, tachycardia, and splenic
sequestration. Which finding is most concerning?
A) Hemoglobin of 10 g/dL
B) Sudden drop in hemoglobin to 5 g/dL with left upper quadrant pain
C) Mild jaundice
D) Pain in the hands and feet
Correct Answer: B
Rationale: Splenic sequestration crisis is a life-threatening complication of sickle cell
disease characterized by rapid pooling of blood in the spleen, causing sudden severe
anemia, hypovolemia, and shock. A sudden drop in hemoglobin with left upper
quadrant pain requires immediate intervention, including IV fluids and possible
transfusion. Mild jaundice and hand-foot syndrome are common but less acutely
dangerous.
Question 6
A nurse is caring for a child receiving chemotherapy. Which laboratory value
indicates the need for neutropenic precautions?
A) Platelet count 200,000/mm³
B) ANC 400/mm³
C) Hemoglobin 11 g/dL
D) WBC 8,000/mm³
Correct Answer: B
Rationale: An ANC below 500/mm³ requires neutropenic precautions, including a
private room, strict hand hygiene, and avoidance of fresh flowers, raw fruits, and
vegetables. Platelet count, hemoglobin, and total WBC within normal limits do not
require these precautions.
, Question 7
A child with a brain tumor is receiving dexamethasone. Which adverse effect should
the nurse monitor?
A) Hypoglycemia
B) Weight loss
C) Hyperglycemia and increased appetite
D) Bradycardia
Correct Answer: C
Rationale: Dexamethasone is a corticosteroid commonly used to reduce cerebral
edema in children with brain tumors. Adverse effects include hyperglycemia,
increased appetite, weight gain, mood changes, and immunosuppression.
Hypoglycemia and weight loss are not typical. Bradycardia is not a common effect.
Question 8
A nurse is assessing a child with suspected Wilms tumor. Which nursing intervention
is the most important?
A) Avoid any further palpation of the abdomen
B) Palpate deeply to determine the size of the mass
C) Check for rebound tenderness in the lower quadrants
D) Palpate only when the child is in a prone position
Correct Answer: A
Rationale: Wilms tumor (nephroblastoma) is an encapsulated tumor of the kidney.
Vigorous or even routine palpation of the abdomen can cause the capsule to rupture,
leading to the seeding of cancer cells throughout the peritoneal cavity. Nursing care
must focus on placing a "Do Not Palpate" sign at the bedside.
Question 9
A child with ALL is receiving intrathecal methotrexate. Which position should the
nurse place the child in after the procedure?
A) Supine for 1 hour
B) Flat, lying on the side for 1 hour
