NUR 254 Exam 4 Study Guide with Questions and Answers (GRADED A+) | Galen College of Nursing | Updated 2025

NURSING NUR 254 Exam 4 Study Material (GRADED A) Questions and Answers | Galen College of Nursing Updated 2025NURSING NUR 254 Exam 4 Study Material Updated 2025 Maternal 1. The nurse is caring for a child who has leukemia with a white blood cell (WBC) count of < 1000 mm. Which of the following should the nurse include in the child’s plan of care? a. Administer prescribed influenza vaccination b. Assign the child to a room with other children c. Allow the child to play with other children who do not have a fever d. Use sterile techniques for any procedures 2. The nurse is providing a teaching session to the health care staff regarding osteosarcoma. Which of the following statements by an attendee indicates a need for additional teaching? a. “A common clinical manifestation is limping if a weight-bearing limb is affected.” b. “The sternum is the most common site of this sarcoma.” c. “Children typically experience pain at the primary tumor site.” d. “In the early stage, the symptoms of this disease are usually attributed to normal growing pains.” 3. The nurse is caring for a child who is suspected of having a Wilm’s tumor. Which of the following actions by the nurse indicates the need for additional training? a. Instructing the parents that the child needs to remain in bed. b. Preventing a child from playing tag in the playroom. c. Requesting a bland soft diet for the child. d. Palpating the child’s abdomen. 4. The nurse is caring for a 5-year-old child who has sickle cell disease (SCD). An assessment of the child includes the following: respirations 10 and unarousable. The child is currently on intravenous (IV) fluids and continuous IV morphine sulfate Based on the assessment information, which of the following actions should the nurse take first? a. Increase the IV fluids to decrease vaso-occlusion. b. Obtain a complete metabolic laboratory blood sample. c. Elevate the head of the bed (HOB) to increase oxygen saturation. d. Administer naloxone to reverse the effect of the morphine. 5. The nurse is admitting a child who has a vaso-occlusive sickle cell crisis. Which of the following interventions should the nurse anticipate to be prescribed for the child? a. Correction of alkalosis and reduction of energy expenditure. b. Globulins and factor VIII replacement. c. Hydration and pain management. d. Electrolyte replacement and administration of heparin. 6. The nurse working in the emergency department (ED) is caring for a child who has hemophilia and developed a swollen knee after falling off a bicycle. The nurse is teaching the child’s parents about care when similar incidents occur at home in the future. Which of the following actions should the nurse teach the parents? a. Take the child to the nearest emergency department (ED). b. Keep the child’s affected knee below the level of the heart. c. Apply an ice pack and compression dressings to the knee. d. Administer recommended dose of aspirin.7. The newly hired nurse is talking with the nurse preceptor about the prevention of irondeficiency anemia in infants. Which of the following statements by the newly hired nurse is correct regarding prevention of this condition? a. “Whole cow’s milk should not be given until 1 year of age with limited daily intake.” b. “Ferrous sulfate drops are contraindicated in infants less than 6 months of age.” c. “Iron-fortified commercial formula should be given for the first 6 months of life.” d. “Iron-fortified infant cereal should be introduced to infants at 10 months.” 8. The nurse is assessing a child who has severe iron deficiency anemia. Which of the following assessment finds should the nurse expect to observe? a. Pallor. b. Painful swelling of the hands. c. An enlarged abdomen. d. Visual disturbances……….. 9. The nurse is caring for 4-year-old child who is 36 hours postoperative following a removal of a Wilm’s tumor. Which of the following requires immediate follow up by the nurse? a. White blood cell (WBC) count of 15.0 mm³. b. Bowel sounds present in all 4 quadrants. c. Temperature of 100.4˚ F that occurs 1 time in a 24-hour period. d. Incision site is pink at the edges. 10. 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? a. “I will need to begin slowly reintroducing my child into social interaction.” b. “We will provide pain relief using pain medication and rest.” c. “A protective helmet will need to be worn until the incision is healed.” d. “An increase in temperature is expected after surgery.”…… 11. The nurse is caring for a child who has increased intracranial pressure (ICP) and is in stable condition. Which of the following interventions should the nurse implement to decrease ICP in the child? a. Limit number of visitors inside the child’s room. b. Keep the child positioned on the left side. c. Administer opioids for pain control. d. Administer hypertonic intravenous (IV) fluids. 12. 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? a. Change the child’s body position every 2 hours. b. Provide the child a quiet atmosphere with dimmed lighting. c. Administer salicylates for increased temperature every 4 hours as needed (PRN). d. Assess for diplopia in both of the child’s eyes. ……….13. 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? a. Decrease noxious olfactory stimuli. b. Maintain a lighted environment. c. Assessing neurological status every 2-4 hours. d. Administer morphine sulfate………….. 14. 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? a. Evidence of head lag at age 1 month. b. Failure to sit up without support by age 6 months. c. Poor head control. d. Smiling by age 3 months. 15. 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? a. Interest in various activities. b. Continuous eye contact. c. Monotone speech. d. Good social interaction. 16. 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? a. Antianxiety medications and homeschooling. b. Psychostimulant medications and behavior modification. c. Anticonvulsant medications and cognitive therapy. d. Antidepressant medications and family therapy. 17. 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? a. Depressed nasal bridge. b. Protruding tongue. c. Large stature for chronological age. d. Hyperflexibility. 18. 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? a. Take complete set of vital signs (VS). b. Comfort the child while the linens are changed. c. Administer an antiemetic as prescribed. d. Complete a neurological assessment.19. 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? a. Apply 2 L of oxygen via face mask. b. Notify child protective services (CPS). c. Ask the parents if they have a history of abuse. d. Explain the child will be able to go home shortly. 20. 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? a. Keep the head elevated slightly. b. Checking pupil reaction every 4 hours. c. Assess for neck stiffness. d. Allowing the child to have 2 visitors at a time in the room. 21. The nurse is assessing a child in a coma and notes that the child has decorticate posturing. Which of the following findings should the nurse expect the child to demonstrate? a. Rigid extension with head arched back, arms extended by the sides, and legs extended. b. Abnormal flexion of upper and lower extremities. c. Rigid flexion with elbows, wrists and fingers flexed, and legs extended and rotated inward. d. Abnormal extensions of the upper extremities and flexion of lower extremities. 22. The nurse is admitting a toddler who is being hospitalized following a near-drowning accident/submersion injury. The child’s mother states to the nurse, “This is unnecessary. My child seems perfectly fine.” What is an appropriate response for the nurse to provide to the mother? a. “Complications can still occur with your child.” b. “It is important to observe your child for the development of seizure activity.” c. “We are required by law to admit your child for observation.” d. “Your child will need extra oxygen for the next 24 to 48 hours.” 23. The nurse is caring for an infant who is having an active seizure. Which of the following actions should the nurse perform when caring for the infant during a seizure? a. Place a pacifier in the infant’s mouth to protect the tongue. b. Suction any secretions out of the infant’s mouth. c. Hold the infant down in the crib to keep them safe. d. Remove any items out of the crib that can harm the infant. 24. The nurse is caring for an infant with a myelomeningocele sac. Which of the following interventions demonstrates appropriate care for the infant? a. Keep the infant in the supine position unless feeding. b. Use latex-free medical products. c. Change the dressing every 6 hours to keep the sac from drying out. d. Secure the diaper tightly on the infant.25. The school nurse is instructing a school-age child who has diabetes mellitus (type 1). The child participates in soccer practice 3 afternoons a week. Which of the following statements by the child indicates a correct understanding of how to prevent hypoglycemia during practice? a. “I will eat twice the amount I normally eat at lunchtime.” b. “I will drink a diet beverage 10 minutes prior to activity.” c. “I will take my prescribed insulin at noontime rather than in the morning.” d. “I will eat a small box of raisins or a cup of juice before soccer practice.” 26. The nurse is preparing discharge instructions for a child who has precocious puberty. Which of the following should the nurse include in the teaching? a. Explain the importance for the child to have peers of the same age. b. Advise the parents to decrease social activities with the opposite sex. c. Advise the parents to consider birth control for their child. d. Counsel parents that there is no treatment currently for this disorder. 27. The nurse is teaching a 10-year-old child and the parents about scoliosis and treatment options. Which of the following should the nurse include when teaching about scoliosis? a. Use of a brace will slow the progression of scoliosis for most clients. b. The Milwaukee brace does not include a neck ring. c. By adolescence, most children outgrow this condition. d. Surgery is required for curves 15 to 30 decrees. 28. The nurse is caring of a 12-year-old child who has acute osteomyelitis in the right foot. The child’s parents ask the nurse if the child can go to the activity room. Which of the following responses should the nurse reply to the parents? a. “I’m sorry. Your child is in isolation and has to stay in the room.” b. “Let me get wheelchair for your child to help keep the foot supported.” c. “Unfortunately, your child will be on bedrest for the next 4 weeks.” d. “Sure. Your child can walk slowly to the activity room.” 29. The nurse working in a community clinic is teaching the mother of an infant who was recently diagnosed with congenital hypothyroidism. Which of the following instructions should the nurse give the mother about the administration of prescribed levothyroxine? a. “Infants typically stay on this medication until adolescent age.” b. “Dissolve the medication and put in a full bottle of formula to disguise the taste.” c. “Give the medication one hour after a feeding.” d. “Give the crushed medication in a small amount of formula and give before giving a bottle.” 30. The nurse is preparing to teach a parent about how to care for a child who has impetigo contagiosa. Which of the following should the nurse include in the teaching plan? a. Apply bactericidal ointment to lesions. b. The lesions will need to be covered at all times. c. Give the child an antimicrobial bath twice a day. d. Administer aspirin for any pain.31. The nurse working in a clinic is instructing the parent of a child who has atopic dermatitis (eczema) about the administration of a prescribed topical corticosteroid. When instructing the parent about how to apply the cream, it is appropriate for the nurse to instruct the parent to apply a. The cream to the affected area within 10 minutes of completing a tepid bath. b. The cream to the affected area after cleansing with water. c. A thin layer of cream and rub it into the affect area. d. A thick layer of cream to the affected areas and allow it to be absorbed. 32. The school nurse is teaching parents about pediculosis capitis. Which of the following should the nurse include in the teaching plan? a. Infested bed linens should be washed in cold water. b. Pediculosis capitis looks like white flaky particles in concentrated areas of the scalp. c. If treated for an infestation, the child may return to school the following week. d. Children should be instructed to refrain from sharing headbands with others. 33. A nurse is admitting an infant diagnosed with phenylketonuria (PKU). Which of the following should the nurse consider when planning care for this infant? a. Teaching the parents how to feed the child through a percutaneous endoscopic gastronomy (PEG) tube. b. Providing teaching about a low-phenylalanine diet. c. Providing instruction for medication management of PKU. d. Preparing the parents for this terminal condition. 34. The nurse is caring for a 5-year-old child who has been bitten on the leg by a dog. After cleansing the area with soap and water, which of the following actions should the nurse take next? a. Test for Lyme disease. b. Apply a clean pressure dressing. c. Report the bite to the local health department. d. Administer epinephrine. 35. The nurse is teaching the parent of a toddler about insect bites. Which of the following statements by the parents indicates an understanding of the teaching? “If my child ever gets stung by a bee, I will a. Place a cool rag over the area.” b. Drive them to the hospital.” c. Administer intramuscular epinephrine.” d. Remove the stinger immediately.”36. The nurse is caring for the following assigned clients. Which client should the nurse follow up with first? a. The client who had a plaster cast applied 12 hours ago and has an indentation noted in the cast. b. The client who is scheduled to have a repair of a torn knee ligament in 2 hours and needs to go to the bathroom. c. The client who is in skeletal traction and has warmth, redness, and pain in the affected leg. d. The client who had a closed reduction 4 hours ago and is reporting a pain level of 6 on a scale of 0 (no pain) to 10 (severe pain). 37. A nurse is caring for a child who has a new cast and is at risk for compartment syndrome. Which of the following manifestations should the nurse monitor with this child? a. Strong pedal pulse. b. Foot reddish in color. c. Paresthesia. d. Looseness of the cast. 38. The nurse is caring for an infant who is undergoing serial casting for the correction of clubfoot and has had the initial cast applies. Which of the following actions should the nurse teach the parents? a. Place the client on a special air mattress bed. b. Cover the cast with towels to keep it clean. c. Limit range of motion (ROM) activities in the ankles. d. Perform neurovascular checks every 2 hours. 39. The nurse is caring for a child who is diagnosed with severe scoliosis. Which of the following prescriptions should the nurse expect to be ordered? a. A prescription for physical therapy for strengthening. b. A referral to an orthopedic surgeon for surgery. c. Continued monitoring for worsening of the curvature. d. Prescription for a Boston brace for stabilization. 40. The nurse manager is providing an in-service to nursing staff about juvenile idiopathic arthritis (JIA). Which of the following statements by a staff member indicates a need for additional teaching? a. “Physical challenges facing children with JIA are pain and exercising.” b. “JIA tends to disappear after age 15.” c. “The nurse should be aware of alterations in growth and development in children with JIA.” d. “There is no cure for JIA.” 41. The nurse is giving discharge instructions to the parents of an infant in a Pavlik harness. Which of the following statements by a parent indicates the need for further instructions?a. “I will keep my infant in the harness 24 hours a day unless directed otherwise by my doctor.” b. “I have to keep my infant in this harness for 6 to 12 weeks.” c. “I have to take my infant back to the doctor every 1 to 2 weeks to check on the harness and the position of the hips.” d. “I will loosen the straps when bathing my infant so all areas of the skin can be cleansed.” 42. The nurse is teaching parents of a 2-year-old child who has a hip Spica cast about care management when discharged home. Which of the following statements by the parents indicates a need for further teaching? a. “Our child can stand in the cast while we support them.” b. “For feedings, we can place our child on our lap to prevent choking.” c. “We should use a super-absorbent diaper tucked beneath the perineal area.” d. “A wagon with side rails can be used instead of a stroller when moving around.” 43. The nurse is caring for an adolescent with a fracture. Which of the following nursing interventions is a priority? a. Encourage frequent resting. b. Provide pain medication. c. Provide activities for distraction. d. Encourage peer visitation. 44. The nurse is caring for a client who has a fracture of the right femur with a newly applied cast. Which of the following assessment findings should the nurse report to the primary health care provider (PHCP) immediately? a. An unrelenting pain that is unrelieved by pain medication. b. A 3+ pedal pulse in the affected extremity. c. The affected extremity is pale with sensation present. d. The capillary refill is 2 seconds.