NSG 3600 Exam 3 | NSG 3600 Children’s
Health | Questions & Answers with
Rationales 2026/2027 Update
QUESTION 1
A pediatric nurse is assessing a school-age child admitted with acute
glomerulonephritis. Which laboratory finding is expected when reviewing the
child's diagnostic results?
A) Elevated antistreptolysin O (ASO) titer and hematuria
B) Decreased serum IgE and normal urinalysis
C) Massive proteinuria exceeding 3.5 grams per 24 hours
D) Markedly elevated blood glucose and positive serum ketones
Answer: A
Rationale: Acute post-streptococcal glomerulonephritis (APSGN) is preceded by a
group A beta-hemolytic streptococcal infection, which is confirmed by an elevated
antistreptolysin O (ASO) titer. Urinalysis characteristically reveals gross or
microscopic hematuria, red blood cell casts, and mild proteinuria. Massive
proteinuria is a hallmark of nephrotic syndrome, not APSGN.
QUESTION 2
A nurse is caring for an infant diagnosed with congenital hypothyroidism. What is
the primary medical management required to prevent permanent neurocognitive
impairment?
A) Lifelong daily oral levothyroxine hormone replacement therapy
B) Weekly intravenous immunoglobulin infusions
C) Short-term oral corticosteroid therapy for 14 days
D) High-dose insulin injections prior to feedings
,Answer: A
Rationale: Congenital hypothyroidism requires lifelong daily administration of oral
levothyroxine to maintain normal thyroid hormone levels, which are critical for
typical brain and skeletal development during infancy. Delayed treatment leads to
irreversible cognitive impairment (cretinism).
QUESTION 3
A nurse is assessing an adolescent client with newly diagnosed type 1 diabetes
mellitus who is experiencing a diabetic ketoacidosis (DKA) episode. Which
electrolyte imbalance is frequently present upon admission due to osmotic
diuresis and intracellular shifts?
A) Total body potassium depletion despite normal or elevated serum potassium
levels
B) Profound hypercalcemia and hypomagnesemia
C) Severe hypernatremia with fluid overload
D) Isolated metabolic alkalosis
Answer: A
Rationale: Osmotic diuresis, acidosis, and insulin deficiency cause potassium to
shift out of cells and be excreted in the urine, resulting in total body potassium
depletion even though initial serum potassium levels may appear normal or
elevated due to extracellular shifting. Once insulin therapy is initiated, potassium
drives back into cells, precipitating hypokalemia.
QUESTION 4
A nurse is providing health teaching to the parents of a school-age child with type
1 diabetes mellitus regarding sick-day management. Which instruction is
essential?
A) Continue taking insulin even if the child is vomiting, monitor blood glucose and
urine ketones every 3 to 4 hours, and encourage fluid intake.
B) Stop taking all insulin immediately if the child refuses meals.
C) Double the rapid-acting insulin dose without checking blood glucose levels.
,D) Restrict all oral fluids to prevent nausea and emesis.
Answer: A
Rationale: During illness, stress hormones increase blood glucose levels even
when food intake decreases. Insulin must never be stopped. Monitoring glucose
and ketones frequently, maintaining hydration with sugar-free fluids, and
contacting the provider for moderate-to-high ketones prevent progression to
DKA.
QUESTION 5
A nurse is caring for a child with sickle cell disease who presents with sudden
severe anemia, profound lethargy, and massive hepatosplenomegaly. Which
acute crisis should the nurse suspect?
A) Splenic sequestration crisis
B) Vaso-occlusive pain crisis
C) Aplastic crisis secondary to parvovirus B19
D) Acute chest syndrome
Answer: A
Rationale: Splenic sequestration crisis occurs when a large volume of blood pools
in the spleen, causing rapid, massive splenomegaly, severe hypovolemic shock,
and profound acute anemia. It is a life-threatening emergency in young children
with sickle cell anemia.
QUESTION 6
A nurse is assessing a child with hemophilia A who experienced a traumatic knee
injury. Which laboratory test result is characteristically prolonged in hemophilia
A?
A) Activated Partial Thromboplastin Time (aPTT)
B) Prothrombin Time (PT)
C) Platelet count
D) Bleeding time
, Answer: A
Rationale: Hemophilia A is an X-linked recessive deficiency of clotting Factor VIII,
which participates in the intrinsic coagulation pathway. This deficiency causes a
prolonged Activated Partial Thromboplastin Time (aPTT), whereas Prothrombin
Time (PT) and platelet count remain normal.
QUESTION 7
A nurse is caring for a child with idiopathic thrombocytopenic purpura (ITP) who
has a platelet count of 15,000/mcL and active mucosal bleeding. Which
medication is an appropriate first-line treatment?
A) Intravenous Immunoglobulin (IVIG) or systemic corticosteroids
B) Subcutaneous regular insulin
C) Intravenous broad-spectrum antibiotics
D) Oral iron supplements alone
Answer: A
Rationale: Initial management for symptomatic ITP with very low platelets and
bleeding manifestations includes intravenous immune globulin (IVIG) or
corticosteroids (such as prednisone) to suppress immune-mediated platelet
destruction by the reticuloendothelial system.
QUESTION 8
A nurse is reviewing laboratory results for an adolescent undergoing
chemotherapy for acute lymphoblastic leukemia (ALL). The Absolute Neutrophil
Count (ANC) is 450/mm3. How should the nurse interpret this value?
A) Severe neutropenia, placing the client at high risk for life-threatening infections
B) Normal hematopoiesis with adequate immune defense
C) Leukocytosis indicating active bacterial infection
D) Absolute polycythemia requiring immediate phlebotomy
Answer: A
Health | Questions & Answers with
Rationales 2026/2027 Update
QUESTION 1
A pediatric nurse is assessing a school-age child admitted with acute
glomerulonephritis. Which laboratory finding is expected when reviewing the
child's diagnostic results?
A) Elevated antistreptolysin O (ASO) titer and hematuria
B) Decreased serum IgE and normal urinalysis
C) Massive proteinuria exceeding 3.5 grams per 24 hours
D) Markedly elevated blood glucose and positive serum ketones
Answer: A
Rationale: Acute post-streptococcal glomerulonephritis (APSGN) is preceded by a
group A beta-hemolytic streptococcal infection, which is confirmed by an elevated
antistreptolysin O (ASO) titer. Urinalysis characteristically reveals gross or
microscopic hematuria, red blood cell casts, and mild proteinuria. Massive
proteinuria is a hallmark of nephrotic syndrome, not APSGN.
QUESTION 2
A nurse is caring for an infant diagnosed with congenital hypothyroidism. What is
the primary medical management required to prevent permanent neurocognitive
impairment?
A) Lifelong daily oral levothyroxine hormone replacement therapy
B) Weekly intravenous immunoglobulin infusions
C) Short-term oral corticosteroid therapy for 14 days
D) High-dose insulin injections prior to feedings
,Answer: A
Rationale: Congenital hypothyroidism requires lifelong daily administration of oral
levothyroxine to maintain normal thyroid hormone levels, which are critical for
typical brain and skeletal development during infancy. Delayed treatment leads to
irreversible cognitive impairment (cretinism).
QUESTION 3
A nurse is assessing an adolescent client with newly diagnosed type 1 diabetes
mellitus who is experiencing a diabetic ketoacidosis (DKA) episode. Which
electrolyte imbalance is frequently present upon admission due to osmotic
diuresis and intracellular shifts?
A) Total body potassium depletion despite normal or elevated serum potassium
levels
B) Profound hypercalcemia and hypomagnesemia
C) Severe hypernatremia with fluid overload
D) Isolated metabolic alkalosis
Answer: A
Rationale: Osmotic diuresis, acidosis, and insulin deficiency cause potassium to
shift out of cells and be excreted in the urine, resulting in total body potassium
depletion even though initial serum potassium levels may appear normal or
elevated due to extracellular shifting. Once insulin therapy is initiated, potassium
drives back into cells, precipitating hypokalemia.
QUESTION 4
A nurse is providing health teaching to the parents of a school-age child with type
1 diabetes mellitus regarding sick-day management. Which instruction is
essential?
A) Continue taking insulin even if the child is vomiting, monitor blood glucose and
urine ketones every 3 to 4 hours, and encourage fluid intake.
B) Stop taking all insulin immediately if the child refuses meals.
C) Double the rapid-acting insulin dose without checking blood glucose levels.
,D) Restrict all oral fluids to prevent nausea and emesis.
Answer: A
Rationale: During illness, stress hormones increase blood glucose levels even
when food intake decreases. Insulin must never be stopped. Monitoring glucose
and ketones frequently, maintaining hydration with sugar-free fluids, and
contacting the provider for moderate-to-high ketones prevent progression to
DKA.
QUESTION 5
A nurse is caring for a child with sickle cell disease who presents with sudden
severe anemia, profound lethargy, and massive hepatosplenomegaly. Which
acute crisis should the nurse suspect?
A) Splenic sequestration crisis
B) Vaso-occlusive pain crisis
C) Aplastic crisis secondary to parvovirus B19
D) Acute chest syndrome
Answer: A
Rationale: Splenic sequestration crisis occurs when a large volume of blood pools
in the spleen, causing rapid, massive splenomegaly, severe hypovolemic shock,
and profound acute anemia. It is a life-threatening emergency in young children
with sickle cell anemia.
QUESTION 6
A nurse is assessing a child with hemophilia A who experienced a traumatic knee
injury. Which laboratory test result is characteristically prolonged in hemophilia
A?
A) Activated Partial Thromboplastin Time (aPTT)
B) Prothrombin Time (PT)
C) Platelet count
D) Bleeding time
, Answer: A
Rationale: Hemophilia A is an X-linked recessive deficiency of clotting Factor VIII,
which participates in the intrinsic coagulation pathway. This deficiency causes a
prolonged Activated Partial Thromboplastin Time (aPTT), whereas Prothrombin
Time (PT) and platelet count remain normal.
QUESTION 7
A nurse is caring for a child with idiopathic thrombocytopenic purpura (ITP) who
has a platelet count of 15,000/mcL and active mucosal bleeding. Which
medication is an appropriate first-line treatment?
A) Intravenous Immunoglobulin (IVIG) or systemic corticosteroids
B) Subcutaneous regular insulin
C) Intravenous broad-spectrum antibiotics
D) Oral iron supplements alone
Answer: A
Rationale: Initial management for symptomatic ITP with very low platelets and
bleeding manifestations includes intravenous immune globulin (IVIG) or
corticosteroids (such as prednisone) to suppress immune-mediated platelet
destruction by the reticuloendothelial system.
QUESTION 8
A nurse is reviewing laboratory results for an adolescent undergoing
chemotherapy for acute lymphoblastic leukemia (ALL). The Absolute Neutrophil
Count (ANC) is 450/mm3. How should the nurse interpret this value?
A) Severe neutropenia, placing the client at high risk for life-threatening infections
B) Normal hematopoiesis with adequate immune defense
C) Leukocytosis indicating active bacterial infection
D) Absolute polycythemia requiring immediate phlebotomy
Answer: A
