Galen NSG 3600 Exam 4 | Nursing Practice – Leadership (2026)
Actual Q&A PDF
1. A nurse is assessing a child with suspected Wilms tumor. Which finding is most consistent
with this diagnosis?
A) Painless, palpable abdominal mass
B) Projectile vomiting after feeding
C) Clay-colored stools and dark urine
D) Red, "currant jelly" stools
Correct Answer: Painless, palpable abdominal mass
Rationale: Wilms tumor (nephroblastoma) is the most common renal tumor in children. It
typically presents as a painless, palpable abdominal mass. The nurse should avoid palpating the
abdomen excessively to prevent tumor rupture and seeding. The mass is often noted by the
parent during bathing or dressing.
2. A nurse is caring for a child who had surgical resection of a Wilms tumor 36 hours ago. Which
finding requires immediate follow-up?
A) Absent bowel sounds in all four quadrants
B) Serosanguineous drainage on the dressing
C) Pain rating of 4 on a 0-10 scale
D) Temperature of 99.8°F (37.7°C)
Correct Answer: Absent bowel sounds in all four quadrants
Rationale: Absent bowel sounds 36 hours post-operatively may indicate an ileus or bowel
obstruction, which is a significant complication. Serosanguineous drainage, mild pain, and low-
grade fever are expected findings in the early postoperative period.
,3. The nurse is providing discharge instructions to the parents of a child who had surgical
resection of a neuroblastoma 4 days ago. Which statement indicates teaching has been
effective?
A) "I will need to begin slowly reintroducing my child into social interaction."
B) "My child needs to wear a helmet to protect the incision."
C) "I will keep my child isolated from all other children for 6 weeks."
D) "My child can return to full physical activity immediately."
Correct Answer: "I will need to begin slowly reintroducing my child into social interaction."
Rationale: After surgery for neuroblastoma, children need a gradual reintroduction to social
activities to prevent infection and allow for healing. Wearing a helmet is not necessary to
protect an abdominal incision; protecting the incision from trauma is important, but a helmet is
not indicated. Isolation for 6 weeks is excessive, and full physical activity is not recommended
immediately.
4. A nurse is caring for a 5-year-old child with sickle cell disease. Assessment findings include O₂
sat 92%, RR 13, HR 100, and difficult to arouse. The child is on IV fluids and morphine sulfate for
pain control. Which action should the nurse take first?
A) Administer naloxone to reverse the effects of morphine
B) Increase the oxygen flow rate to 4 L/min
C) Notify the healthcare provider immediately
D) Obtain a stat complete blood count
Correct Answer: Administer naloxone to reverse the effects of morphine
Rationale: The child is difficult to arouse with a low respiratory rate of 13, which suggests
respiratory depression from morphine. Naloxone should be administered to reverse the opioid
,effects. Oxygen should be applied, vital signs monitored, and the provider notified, but
reversing the respiratory depression is the priority.
5. A child presents with a red streak up the arm. What should the nurse do?
A) Report immediately
B) Apply a warm compress
C) Administer an antihistamine
D) Document the finding and continue to monitor
Correct Answer: Report immediately
Rationale: A red streak extending up the arm is a sign of lymphangitis or ascending infection,
which can indicate sepsis. This requires immediate reporting to the healthcare provider for
prompt treatment with antibiotics.
6. A child with sickle cell disease is experiencing a vaso-occlusive crisis. Which nursing
intervention is a priority?
A) Administer IV fluids and analgesics
B) Apply cold compresses to painful joints
C) Restrict oral fluid intake
D) Encourage the child to ambulate frequently
Correct Answer: Administer IV fluids and analgesics
Rationale: A vaso-occlusive crisis in sickle cell disease requires aggressive pain management
with IV analgesics and hydration to dilute sickled cells and improve perfusion. Cold compresses
can cause vasoconstriction and worsen the crisis. Ambulation may be limited due to pain.
, 7. A nurse is providing discharge teaching to the parents of a child with hemophilia A. Which
instruction is most important?
A) Administer factor VIII replacement as prescribed
B) Administer aspirin for pain management
C) Encourage contact sports for socialization
D) Apply heat to bleeding joints
Correct Answer: Administer factor VIII replacement as prescribed
Rationale: Hemophilia A is treated with factor VIII replacement therapy to prevent and manage
bleeding episodes. Aspirin should be avoided due to its antiplatelet effects, contact sports are
contraindicated, and cold (not heat) should be applied to bleeding joints.
8. A child is diagnosed with acute lymphoblastic leukemia (ALL). The nurse understands that the
primary treatment for ALL is:
A) Radiation therapy
B) Bone marrow transplant
C) Chemotherapy
D) Immunotherapy
Correct Answer: Chemotherapy
Rationale: The primary treatment for acute lymphoblastic leukemia (ALL) is chemotherapy,
which is often given in phases: induction, consolidation, and maintenance. Radiation therapy,
bone marrow transplant, and immunotherapy may be used in specific cases but are not the
primary treatment.
9. A child with cancer is receiving chemotherapy and develops febrile neutropenia. Which
nursing intervention is the priority?
Actual Q&A PDF
1. A nurse is assessing a child with suspected Wilms tumor. Which finding is most consistent
with this diagnosis?
A) Painless, palpable abdominal mass
B) Projectile vomiting after feeding
C) Clay-colored stools and dark urine
D) Red, "currant jelly" stools
Correct Answer: Painless, palpable abdominal mass
Rationale: Wilms tumor (nephroblastoma) is the most common renal tumor in children. It
typically presents as a painless, palpable abdominal mass. The nurse should avoid palpating the
abdomen excessively to prevent tumor rupture and seeding. The mass is often noted by the
parent during bathing or dressing.
2. A nurse is caring for a child who had surgical resection of a Wilms tumor 36 hours ago. Which
finding requires immediate follow-up?
A) Absent bowel sounds in all four quadrants
B) Serosanguineous drainage on the dressing
C) Pain rating of 4 on a 0-10 scale
D) Temperature of 99.8°F (37.7°C)
Correct Answer: Absent bowel sounds in all four quadrants
Rationale: Absent bowel sounds 36 hours post-operatively may indicate an ileus or bowel
obstruction, which is a significant complication. Serosanguineous drainage, mild pain, and low-
grade fever are expected findings in the early postoperative period.
,3. The nurse is providing discharge instructions to the parents of a child who had surgical
resection of a neuroblastoma 4 days ago. Which statement indicates teaching has been
effective?
A) "I will need to begin slowly reintroducing my child into social interaction."
B) "My child needs to wear a helmet to protect the incision."
C) "I will keep my child isolated from all other children for 6 weeks."
D) "My child can return to full physical activity immediately."
Correct Answer: "I will need to begin slowly reintroducing my child into social interaction."
Rationale: After surgery for neuroblastoma, children need a gradual reintroduction to social
activities to prevent infection and allow for healing. Wearing a helmet is not necessary to
protect an abdominal incision; protecting the incision from trauma is important, but a helmet is
not indicated. Isolation for 6 weeks is excessive, and full physical activity is not recommended
immediately.
4. A nurse is caring for a 5-year-old child with sickle cell disease. Assessment findings include O₂
sat 92%, RR 13, HR 100, and difficult to arouse. The child is on IV fluids and morphine sulfate for
pain control. Which action should the nurse take first?
A) Administer naloxone to reverse the effects of morphine
B) Increase the oxygen flow rate to 4 L/min
C) Notify the healthcare provider immediately
D) Obtain a stat complete blood count
Correct Answer: Administer naloxone to reverse the effects of morphine
Rationale: The child is difficult to arouse with a low respiratory rate of 13, which suggests
respiratory depression from morphine. Naloxone should be administered to reverse the opioid
,effects. Oxygen should be applied, vital signs monitored, and the provider notified, but
reversing the respiratory depression is the priority.
5. A child presents with a red streak up the arm. What should the nurse do?
A) Report immediately
B) Apply a warm compress
C) Administer an antihistamine
D) Document the finding and continue to monitor
Correct Answer: Report immediately
Rationale: A red streak extending up the arm is a sign of lymphangitis or ascending infection,
which can indicate sepsis. This requires immediate reporting to the healthcare provider for
prompt treatment with antibiotics.
6. A child with sickle cell disease is experiencing a vaso-occlusive crisis. Which nursing
intervention is a priority?
A) Administer IV fluids and analgesics
B) Apply cold compresses to painful joints
C) Restrict oral fluid intake
D) Encourage the child to ambulate frequently
Correct Answer: Administer IV fluids and analgesics
Rationale: A vaso-occlusive crisis in sickle cell disease requires aggressive pain management
with IV analgesics and hydration to dilute sickled cells and improve perfusion. Cold compresses
can cause vasoconstriction and worsen the crisis. Ambulation may be limited due to pain.
, 7. A nurse is providing discharge teaching to the parents of a child with hemophilia A. Which
instruction is most important?
A) Administer factor VIII replacement as prescribed
B) Administer aspirin for pain management
C) Encourage contact sports for socialization
D) Apply heat to bleeding joints
Correct Answer: Administer factor VIII replacement as prescribed
Rationale: Hemophilia A is treated with factor VIII replacement therapy to prevent and manage
bleeding episodes. Aspirin should be avoided due to its antiplatelet effects, contact sports are
contraindicated, and cold (not heat) should be applied to bleeding joints.
8. A child is diagnosed with acute lymphoblastic leukemia (ALL). The nurse understands that the
primary treatment for ALL is:
A) Radiation therapy
B) Bone marrow transplant
C) Chemotherapy
D) Immunotherapy
Correct Answer: Chemotherapy
Rationale: The primary treatment for acute lymphoblastic leukemia (ALL) is chemotherapy,
which is often given in phases: induction, consolidation, and maintenance. Radiation therapy,
bone marrow transplant, and immunotherapy may be used in specific cases but are not the
primary treatment.
9. A child with cancer is receiving chemotherapy and develops febrile neutropenia. Which
nursing intervention is the priority?
