Galen NSG 3600 Exam 3 | Nursing Practice – Leadership (2026)
Actual Q&A PDF
1. The nurse is caring for a 3-month-old infant with suspected hypertrophic pyloric stenosis
(HPS). Which assessment finding is most consistent with this diagnosis?
A) Projectile vomiting after feeding
B) Bilious emesis
C) Watery, foul-smelling diarrhea
D) Abdominal distention with visible peristaltic waves from left to right
Correct Answer: Projectile vomiting after feeding
Rationale: Hypertrophic pyloric stenosis (HPS) is characterized by non-bilious projectile vomiting
that typically occurs 30-60 minutes after feeding. The vomitus is forceful and may project
several feet. The infant is usually hungry after vomiting. Bilious emesis suggests a bowel
obstruction distal to the ampulla of Vater. A palpable olive-shaped mass may be felt in the right
upper quadrant.
2. A nurse is providing postoperative teaching to the parents of an infant who had a
pyloromyotomy. Which instruction is most important?
A) "Feed your infant 4 hours after the procedure."
B) "Report any vomiting that occurs 24-36 hours after surgery."
C) "Give over-the-counter aspirin for pain."
D) "Check for good skin turgor and hydration status."
Correct Answer: "Report any vomiting that occurs 24-36 hours after surgery."
Rationale: After a pyloromyotomy, some vomiting may occur in the immediate postoperative
period, but vomiting that persists or returns 24-36 hours after surgery should be reported as it
,may indicate complications. Feedings are typically resumed with small, frequent amounts of
clear liquids, not 4 hours later. Aspirin should be avoided due to the risk of Reye's syndrome.
3. A nurse is caring for a child with intussusception. Which assessment finding is most
characteristic of this condition?
A) Black, tarry stools
B) A palpable olive-shaped mass in the right upper quadrant
C) Intermittent, severe abdominal pain with drawing up of the knees
D) Insatiable appetite and failure to thrive
Correct Answer: Intermittent, severe abdominal pain with drawing up of the knees
Rationale: Intussusception is characterized by sudden, intermittent, severe abdominal pain that
causes the child to draw the knees up to the chest (currant jelly stools are a late sign). The child
may appear comfortable between episodes of pain. A palpable sausage-shaped mass may be
felt in the right upper quadrant. The intermittent nature of the pain is a key distinguishing
feature.
4. A child with intussusception is scheduled for surgery. The child passes a normal brown stool.
What is the nurse's priority action?
A) Obtain an abdominal ultrasound
B) Perform a test to check for occult blood in the stool
C) Notify the healthcare provider immediately
D) Document the color and continue to monitor
Correct Answer: Notify the healthcare provider immediately
Rationale: Passage of a normal brown stool in a child with suspected intussusception may
indicate that the intussusception has reduced spontaneously. However, this is not always the
,case, and the healthcare provider must be notified immediately to determine if further
intervention is needed. This is a critical assessment finding that could change the plan of care.
5. The nurse is providing education to the parents of a child diagnosed with Hirschsprung's
disease. Which statement about this condition is correct?
A) "Hirschsprung's disease is caused by a lack of ganglion cells in the colon."
B) "This condition is characterized by frequent, watery diarrhea."
C) "The primary treatment is dietary modification and laxatives."
D) "It is a temporary condition that resolves by age 3."
Correct Answer: "Hirschsprung's disease is caused by a lack of ganglion cells in the colon."
Rationale: Hirschsprung's disease (congenital aganglionic megacolon) is caused by the absence
of ganglion cells in the myenteric and submucosal plexuses of the colon, leading to a lack of
peristalsis and functional obstruction. The primary treatment is surgical removal of the
aganglionic segment. It is a permanent condition present at birth.
6. A child is diagnosed with Hirschsprung's disease and is scheduled for surgery. Which nursing
intervention is most appropriate in the preoperative period?
A) Administer a stimulant laxative daily
B) Perform digital rectal examinations to stimulate bowel movements
C) Monitor for signs of enterocolitis, such as fever and abdominal distention
D) Encourage a high-fiber diet to promote bowel movements
Correct Answer: Monitor for signs of enterocolitis, such as fever and abdominal distention
Rationale: Hirschsprung's-associated enterocolitis is a life-threatening complication that can
occur preoperatively or postoperatively. The nurse should monitor for fever, abdominal
, distention, explosive diarrhea, and signs of sepsis. Laxatives and digital stimulation should be
avoided as they can precipitate enterocolitis.
7. The nurse is teaching parents about celiac disease. Which statement by a parent indicates a
need for further teaching?
A) "Our child can still tolerate corn and rice."
B) "Our child must avoid wheat, barley, and rye."
C) "This is a permanent condition that requires lifelong dietary changes."
D) "Low intake of folic acid is the reason my child has this disease."
Correct Answer: "Low intake of folic acid is the reason my child has this disease."
Rationale: Celiac disease is an autoimmune disorder triggered by gluten (found in wheat, barley,
and rye) in genetically susceptible individuals. It is not caused by low folic acid intake. The
condition is permanent and requires strict lifelong adherence to a gluten-free diet. Corn and rice
are gluten-free and safe for children with celiac disease.
8. A child with celiac disease is experiencing steatorrhea. The nurse understands that
steatorrhea is characterized by:
A) Frequent, watery stools
B) Bulky, frothy, foul-smelling stools
C) Bloody, mucous stools
D) Hard, dry, pellet-like stools
Correct Answer: Bulky, frothy, foul-smelling stools
Rationale: Steatorrhea is the presence of excess fat in the stool, resulting from malabsorption. It
is characterized by bulky, frothy, greasy, and foul-smelling stools. This occurs in celiac disease
due to damage to the intestinal villi, leading to fat malabsorption.
Actual Q&A PDF
1. The nurse is caring for a 3-month-old infant with suspected hypertrophic pyloric stenosis
(HPS). Which assessment finding is most consistent with this diagnosis?
A) Projectile vomiting after feeding
B) Bilious emesis
C) Watery, foul-smelling diarrhea
D) Abdominal distention with visible peristaltic waves from left to right
Correct Answer: Projectile vomiting after feeding
Rationale: Hypertrophic pyloric stenosis (HPS) is characterized by non-bilious projectile vomiting
that typically occurs 30-60 minutes after feeding. The vomitus is forceful and may project
several feet. The infant is usually hungry after vomiting. Bilious emesis suggests a bowel
obstruction distal to the ampulla of Vater. A palpable olive-shaped mass may be felt in the right
upper quadrant.
2. A nurse is providing postoperative teaching to the parents of an infant who had a
pyloromyotomy. Which instruction is most important?
A) "Feed your infant 4 hours after the procedure."
B) "Report any vomiting that occurs 24-36 hours after surgery."
C) "Give over-the-counter aspirin for pain."
D) "Check for good skin turgor and hydration status."
Correct Answer: "Report any vomiting that occurs 24-36 hours after surgery."
Rationale: After a pyloromyotomy, some vomiting may occur in the immediate postoperative
period, but vomiting that persists or returns 24-36 hours after surgery should be reported as it
,may indicate complications. Feedings are typically resumed with small, frequent amounts of
clear liquids, not 4 hours later. Aspirin should be avoided due to the risk of Reye's syndrome.
3. A nurse is caring for a child with intussusception. Which assessment finding is most
characteristic of this condition?
A) Black, tarry stools
B) A palpable olive-shaped mass in the right upper quadrant
C) Intermittent, severe abdominal pain with drawing up of the knees
D) Insatiable appetite and failure to thrive
Correct Answer: Intermittent, severe abdominal pain with drawing up of the knees
Rationale: Intussusception is characterized by sudden, intermittent, severe abdominal pain that
causes the child to draw the knees up to the chest (currant jelly stools are a late sign). The child
may appear comfortable between episodes of pain. A palpable sausage-shaped mass may be
felt in the right upper quadrant. The intermittent nature of the pain is a key distinguishing
feature.
4. A child with intussusception is scheduled for surgery. The child passes a normal brown stool.
What is the nurse's priority action?
A) Obtain an abdominal ultrasound
B) Perform a test to check for occult blood in the stool
C) Notify the healthcare provider immediately
D) Document the color and continue to monitor
Correct Answer: Notify the healthcare provider immediately
Rationale: Passage of a normal brown stool in a child with suspected intussusception may
indicate that the intussusception has reduced spontaneously. However, this is not always the
,case, and the healthcare provider must be notified immediately to determine if further
intervention is needed. This is a critical assessment finding that could change the plan of care.
5. The nurse is providing education to the parents of a child diagnosed with Hirschsprung's
disease. Which statement about this condition is correct?
A) "Hirschsprung's disease is caused by a lack of ganglion cells in the colon."
B) "This condition is characterized by frequent, watery diarrhea."
C) "The primary treatment is dietary modification and laxatives."
D) "It is a temporary condition that resolves by age 3."
Correct Answer: "Hirschsprung's disease is caused by a lack of ganglion cells in the colon."
Rationale: Hirschsprung's disease (congenital aganglionic megacolon) is caused by the absence
of ganglion cells in the myenteric and submucosal plexuses of the colon, leading to a lack of
peristalsis and functional obstruction. The primary treatment is surgical removal of the
aganglionic segment. It is a permanent condition present at birth.
6. A child is diagnosed with Hirschsprung's disease and is scheduled for surgery. Which nursing
intervention is most appropriate in the preoperative period?
A) Administer a stimulant laxative daily
B) Perform digital rectal examinations to stimulate bowel movements
C) Monitor for signs of enterocolitis, such as fever and abdominal distention
D) Encourage a high-fiber diet to promote bowel movements
Correct Answer: Monitor for signs of enterocolitis, such as fever and abdominal distention
Rationale: Hirschsprung's-associated enterocolitis is a life-threatening complication that can
occur preoperatively or postoperatively. The nurse should monitor for fever, abdominal
, distention, explosive diarrhea, and signs of sepsis. Laxatives and digital stimulation should be
avoided as they can precipitate enterocolitis.
7. The nurse is teaching parents about celiac disease. Which statement by a parent indicates a
need for further teaching?
A) "Our child can still tolerate corn and rice."
B) "Our child must avoid wheat, barley, and rye."
C) "This is a permanent condition that requires lifelong dietary changes."
D) "Low intake of folic acid is the reason my child has this disease."
Correct Answer: "Low intake of folic acid is the reason my child has this disease."
Rationale: Celiac disease is an autoimmune disorder triggered by gluten (found in wheat, barley,
and rye) in genetically susceptible individuals. It is not caused by low folic acid intake. The
condition is permanent and requires strict lifelong adherence to a gluten-free diet. Corn and rice
are gluten-free and safe for children with celiac disease.
8. A child with celiac disease is experiencing steatorrhea. The nurse understands that
steatorrhea is characterized by:
A) Frequent, watery stools
B) Bulky, frothy, foul-smelling stools
C) Bloody, mucous stools
D) Hard, dry, pellet-like stools
Correct Answer: Bulky, frothy, foul-smelling stools
Rationale: Steatorrhea is the presence of excess fat in the stool, resulting from malabsorption. It
is characterized by bulky, frothy, greasy, and foul-smelling stools. This occurs in celiac disease
due to damage to the intestinal villi, leading to fat malabsorption.
