NUR 254 Exam 4 [ACTUAL EXAM] LATEST VERSION
[QUESTIONS AND ANSWERS] WITH STUDY GUIDE
DETAILED AND VERIFIED FOR GUARANTEED PASS-
LATEST UPDATE 2025 GRADED A
The nurse is assessing a child who has severe iron deficiency
anemia. Which of the following assessment finds should the nurse
expect to observe? - CORRECT ANSWER Pallor
The nurse is caring for 4-year-old child who is 36 hours postoperative
following a removal of a Wilm'stumor. Which of the following requires
immediate follow up by the nurse? - CORRECT ANSWER Incision
site is pink at the edges.
The nurse is providing discharge instructions to the parents of a child
who had surgical resection of a neuroblastoma 4 days ago. Which of
the following statements by the parents indicates teaching has been
effective? - CORRECT ANSWER We will provide pain relief using
pain medication and rest."
The nurse is caring for a child who has increased intracranial
pressure (ICP) and is in stable condition. Which of the following
interventionsshould the nurse implement to decrease ICP in the
child? - CORRECT ANSWER Limit number of visitors inside the
child's room.
The nurse is caring for a child who has Reye's syndrome. Which of
the following should the nurse include in the child's plan of care -
CORRECT ANSWER Provide the child a quiet atmosphere with
dimmed lighting
The nurse is caring for a child who is suspected of having bacterial
meningitis. The results of the lumbar puncture are still pending.
Which of the following actions by the nurse is the priority? -
CORRECT ANSWER Assessing neurological status every 2-4
hours.
, The nurse is screening infants for early warning signs of cerebral
palsy. Which of the following should the nurse recognize as 1 of the
early warning signs of cerebral palsy? - CORRECT ANSWER Poor
head control
The nurse is assessing a 6-year-old for manifestations of autism
spectrum disorder. Which of the following manifestations should the
nurse expect to observe in this child? - CORRECT ANSWER
Monotone speech
. The nurse is developing a plan of care for a child diagnosed with
attention-deficit hyperactivity disorder (ADHD). Which of the following
information should the nurse include in the plan of care? - CORRECT
ANSWER Psychostimulant medications and behavior modification.
The nurse preceptor is observing a newly hired nurse care for a child
who has Down syndrome. Which of the following manifestations, if
documented by the newly hired nurse, requires follow up by the nurse
preceptor? - CORRECT ANSWER Protruding tongue
The nurse is caring for a child who had a ventricular shunt placement
24 hours ago. The child is sitting up in bed crying and has vomited a
small amount on the bed linens. Which of the following actions
should the nurse take first? - CORRECT ANSWER Complete a
neurological assessment.
The nurse working in the emergency department (ED) is caring for a
2-month-old child who presents with intraocular bleeding,
bradycardia, and bulging fontanels, but no trauma to the head, face,
or neck. Health history and physical examination is incongruent, and
abuse is suspected. Which of the following actions should the nurse
perform? - CORRECT ANSWER Notify child protective services
(CPS)
The nurse is caring for a child who is hospitalized for 24-hour
observation following a head injury. Which of the following actions by
the nurse is the priority? - CORRECT ANSWER Checking pupil
reaction every 4 hours
[QUESTIONS AND ANSWERS] WITH STUDY GUIDE
DETAILED AND VERIFIED FOR GUARANTEED PASS-
LATEST UPDATE 2025 GRADED A
The nurse is assessing a child who has severe iron deficiency
anemia. Which of the following assessment finds should the nurse
expect to observe? - CORRECT ANSWER Pallor
The nurse is caring for 4-year-old child who is 36 hours postoperative
following a removal of a Wilm'stumor. Which of the following requires
immediate follow up by the nurse? - CORRECT ANSWER Incision
site is pink at the edges.
The nurse is providing discharge instructions to the parents of a child
who had surgical resection of a neuroblastoma 4 days ago. Which of
the following statements by the parents indicates teaching has been
effective? - CORRECT ANSWER We will provide pain relief using
pain medication and rest."
The nurse is caring for a child who has increased intracranial
pressure (ICP) and is in stable condition. Which of the following
interventionsshould the nurse implement to decrease ICP in the
child? - CORRECT ANSWER Limit number of visitors inside the
child's room.
The nurse is caring for a child who has Reye's syndrome. Which of
the following should the nurse include in the child's plan of care -
CORRECT ANSWER Provide the child a quiet atmosphere with
dimmed lighting
The nurse is caring for a child who is suspected of having bacterial
meningitis. The results of the lumbar puncture are still pending.
Which of the following actions by the nurse is the priority? -
CORRECT ANSWER Assessing neurological status every 2-4
hours.
, The nurse is screening infants for early warning signs of cerebral
palsy. Which of the following should the nurse recognize as 1 of the
early warning signs of cerebral palsy? - CORRECT ANSWER Poor
head control
The nurse is assessing a 6-year-old for manifestations of autism
spectrum disorder. Which of the following manifestations should the
nurse expect to observe in this child? - CORRECT ANSWER
Monotone speech
. The nurse is developing a plan of care for a child diagnosed with
attention-deficit hyperactivity disorder (ADHD). Which of the following
information should the nurse include in the plan of care? - CORRECT
ANSWER Psychostimulant medications and behavior modification.
The nurse preceptor is observing a newly hired nurse care for a child
who has Down syndrome. Which of the following manifestations, if
documented by the newly hired nurse, requires follow up by the nurse
preceptor? - CORRECT ANSWER Protruding tongue
The nurse is caring for a child who had a ventricular shunt placement
24 hours ago. The child is sitting up in bed crying and has vomited a
small amount on the bed linens. Which of the following actions
should the nurse take first? - CORRECT ANSWER Complete a
neurological assessment.
The nurse working in the emergency department (ED) is caring for a
2-month-old child who presents with intraocular bleeding,
bradycardia, and bulging fontanels, but no trauma to the head, face,
or neck. Health history and physical examination is incongruent, and
abuse is suspected. Which of the following actions should the nurse
perform? - CORRECT ANSWER Notify child protective services
(CPS)
The nurse is caring for a child who is hospitalized for 24-hour
observation following a head injury. Which of the following actions by
the nurse is the priority? - CORRECT ANSWER Checking pupil
reaction every 4 hours
