NUR 254 Exam 3 | Galen College: Pediatric Alterations &
Developmental Milestones Prep with Detailed Rationales
Course Code: NURS 254
Course Name: Pediatric Alterations & Developmental Milestones
Topic: Pediatric Growth, Development, and Systemic Pathologies
Academic Year: 2026/2027
101. A 14-month-old toddler is brought to the pediatric clinic for a
routine wellness evaluation. During developmental surveillance, the mother
asks what gross motor milestones should be mastered by this age. Which
developmental observation indicates a delay requiring further formal
evaluation at this milestone boundary?
A. Inability to run stiffly or kick a large ball forward without losing balance.
, B. Inability to climb up standard household stairs independently.
C. Failure to stand alone or walk independently without support.
D. Inability to jump off a low step with both feet landing simultaneously.
CORRECT ANSWER: C
RATIONALE: Most toddlers achieve independent standing and take their first
steps between 12 and 15 months of age. Failure to stand alone or walk
independently by 14 to 15 months represents a developmental red flag that requires
a formal developmental and neurological evaluation. Distractors A, B, and D
describe gross motor skills (running stiffly, climbing stairs, jumping) that are
developmentally expected between 18 and 36 months of age, and are not
considered delays at 14 months.
102. A 4-year-old child is admitted to the pediatric unit following an
elective tonsillectomy. The nurse assesses the child's postoperative pain
level using the FLACC scale. Which operational parameters are evaluated
when utilizing this specific behavioral pain assessment tool?
A. Focus, Linear orientation, Autonomic response, Crying, and Core
temperature.
B. Face, Legs, Activity, Cry, and Consolability.
C. Facial expression, Location of pain, Aggression, Cognitive ability, and
Coping.
D. Frequency of pain, Longevity of symptoms, Arterial blood pressure,
Clonus, and Color changes.
CORRECT ANSWER: B
RATIONALE: The FLACC scale is a behavioral pain assessment tool
validated for children aged 2 months to 7 years who cannot verbally report their
pain. It evaluates five distinct categories: Face, Legs, Activity, Cry, and
Consolability. Each category is scored from 0 to 2, yielding a total score between
0 and 10. Distractors A, C, and D list incorrect parameters that are not part of this
behavioral scoring metric.
103. An 8-month-old infant is brought to the emergency department
presenting with sudden bouts of severe, screaming abdominal pain during
which he draws his knees up to his chest, followed by periods of lethargy.
The mother reports he passed a stool that resembled "currant jelly." Upon
physical examination, the nurse palpates a sausage-shaped mass in the right
, upper quadrant. What gastrointestinal alteration does this represent?
A. Hypertrophic Pyloric Stenosis.
B. Intussusception.
C. Hirschsprung Disease.
D. Acute Appendicitis.
CORRECT ANSWER: B
RATIONALE: Intussusception is the telescoping of one segment of the
intestine into another, most commonly occurring near the ileocecal valve in infants
aged 3 to 36 months. The classic presentation includes paroxysmal colicky
abdominal pain (with knees drawn to the chest), a palpable sausage-shaped
abdominal mass, and "currant jelly" stools (blood and mucus mixed together).
Distractor A presents with non-bilious, projectile vomiting and an olive-shaped
mass. Distractor C presents with chronic constipation and a ribbon-like stool.
Distractor D is rare in infants and presents with localized right lower quadrant
pain.
104. A 2-year-old toddler is admitted with a diagnosis of acute
Laryngotracheobronchitis (Croup). The child exhibits a harsh, barking
cough, inspiratory stridor at rest, and mild intercostal retractions. Which
pharmacological therapy should the nurse anticipate administering first to
reduce subglottic edema?
A. Intravenous amoxicillin/clavulanate.
B. Continuous nebulized albuterol treatments.
C. Nebulized racemic epinephrine and oral or intramuscular
dexamethasone.
D. Intravenous aminophylline infusion.
CORRECT ANSWER: C
RATIONALE: Laryngotracheobronchitis (Croup) is a viral upper
respiratory infection that causes inflammation and narrowing of the subglottic
airway. First-line therapeutic management for moderate-to-severe croup includes
nebulized racemic epinephrine (which induces local mucosal vasoconstriction to
rapidly reduce airway edema) and corticosteroids (such as dexamethasone) to
provide long-acting anti-inflammatory relief. Distractor A is incorrect because
croup is viral. Distractor B targets the lower airways (bronchospasm) and does not
relieve subglottic stridor. Distractor D is an obsolete bronchodilator therapy.
Developmental Milestones Prep with Detailed Rationales
Course Code: NURS 254
Course Name: Pediatric Alterations & Developmental Milestones
Topic: Pediatric Growth, Development, and Systemic Pathologies
Academic Year: 2026/2027
101. A 14-month-old toddler is brought to the pediatric clinic for a
routine wellness evaluation. During developmental surveillance, the mother
asks what gross motor milestones should be mastered by this age. Which
developmental observation indicates a delay requiring further formal
evaluation at this milestone boundary?
A. Inability to run stiffly or kick a large ball forward without losing balance.
, B. Inability to climb up standard household stairs independently.
C. Failure to stand alone or walk independently without support.
D. Inability to jump off a low step with both feet landing simultaneously.
CORRECT ANSWER: C
RATIONALE: Most toddlers achieve independent standing and take their first
steps between 12 and 15 months of age. Failure to stand alone or walk
independently by 14 to 15 months represents a developmental red flag that requires
a formal developmental and neurological evaluation. Distractors A, B, and D
describe gross motor skills (running stiffly, climbing stairs, jumping) that are
developmentally expected between 18 and 36 months of age, and are not
considered delays at 14 months.
102. A 4-year-old child is admitted to the pediatric unit following an
elective tonsillectomy. The nurse assesses the child's postoperative pain
level using the FLACC scale. Which operational parameters are evaluated
when utilizing this specific behavioral pain assessment tool?
A. Focus, Linear orientation, Autonomic response, Crying, and Core
temperature.
B. Face, Legs, Activity, Cry, and Consolability.
C. Facial expression, Location of pain, Aggression, Cognitive ability, and
Coping.
D. Frequency of pain, Longevity of symptoms, Arterial blood pressure,
Clonus, and Color changes.
CORRECT ANSWER: B
RATIONALE: The FLACC scale is a behavioral pain assessment tool
validated for children aged 2 months to 7 years who cannot verbally report their
pain. It evaluates five distinct categories: Face, Legs, Activity, Cry, and
Consolability. Each category is scored from 0 to 2, yielding a total score between
0 and 10. Distractors A, C, and D list incorrect parameters that are not part of this
behavioral scoring metric.
103. An 8-month-old infant is brought to the emergency department
presenting with sudden bouts of severe, screaming abdominal pain during
which he draws his knees up to his chest, followed by periods of lethargy.
The mother reports he passed a stool that resembled "currant jelly." Upon
physical examination, the nurse palpates a sausage-shaped mass in the right
, upper quadrant. What gastrointestinal alteration does this represent?
A. Hypertrophic Pyloric Stenosis.
B. Intussusception.
C. Hirschsprung Disease.
D. Acute Appendicitis.
CORRECT ANSWER: B
RATIONALE: Intussusception is the telescoping of one segment of the
intestine into another, most commonly occurring near the ileocecal valve in infants
aged 3 to 36 months. The classic presentation includes paroxysmal colicky
abdominal pain (with knees drawn to the chest), a palpable sausage-shaped
abdominal mass, and "currant jelly" stools (blood and mucus mixed together).
Distractor A presents with non-bilious, projectile vomiting and an olive-shaped
mass. Distractor C presents with chronic constipation and a ribbon-like stool.
Distractor D is rare in infants and presents with localized right lower quadrant
pain.
104. A 2-year-old toddler is admitted with a diagnosis of acute
Laryngotracheobronchitis (Croup). The child exhibits a harsh, barking
cough, inspiratory stridor at rest, and mild intercostal retractions. Which
pharmacological therapy should the nurse anticipate administering first to
reduce subglottic edema?
A. Intravenous amoxicillin/clavulanate.
B. Continuous nebulized albuterol treatments.
C. Nebulized racemic epinephrine and oral or intramuscular
dexamethasone.
D. Intravenous aminophylline infusion.
CORRECT ANSWER: C
RATIONALE: Laryngotracheobronchitis (Croup) is a viral upper
respiratory infection that causes inflammation and narrowing of the subglottic
airway. First-line therapeutic management for moderate-to-severe croup includes
nebulized racemic epinephrine (which induces local mucosal vasoconstriction to
rapidly reduce airway edema) and corticosteroids (such as dexamethasone) to
provide long-acting anti-inflammatory relief. Distractor A is incorrect because
croup is viral. Distractor B targets the lower airways (bronchospasm) and does not
relieve subglottic stridor. Distractor D is an obsolete bronchodilator therapy.
