NSG3600 Exam 4 V3 | NSG 3600 Nursing
Practice – Children’s Health Exam Q&A |
Galen College of Nursing
1. A 4-year-old child with leukemia is hospitalized for chemotherapy. Which laboratory value
should the nurse prioritize to determine the child’s risk for infection?
A. Platelet count
B. Absolute Neutrophil Count (ANC)
C. Hemoglobin level
D. Serum creatinine
Answer: B
Rationale: The Absolute Neutrophil Count (ANC) is the most accurate predictor of a child’s
ability to fight infection. An ANC lower than 500/mm³ indicates a severe risk for life-
threatening infections during chemotherapy. Nurses must monitor this value closely to
implement neutropenic precautions and ensure the safety of the immunocompromised
pediatric patient.
2. The nurse is assessing an infant with suspected Tetralogy of Fallot. Which clinical
manifestation is most characteristic of a ‘tet spell’?
A. Bounding peripheral pulses
B. Bradypnea and hypertension
,C. Increased urine output and lethargy
D. Sudden onset of cyanosis and hyperpnea
Answer: D
Rationale: A hypercyanotic spell, often called a ‘tet spell,’ is characterized by a sudden
increase in cyanosis and rapid, deep respirations. This occurs due to an acute decrease in
pulmonary blood flow and an increase in right-to-left shunting. Placing the infant in a knee-
chest position is the priority intervention to increase systemic vascular resistance and
improve oxygenation.
3. When caring for a child with a suspected Wilms tumor, which action is most important for
the nurse to perform?
A. Measure abdominal girth every 4 hours
B. Place a sign over the bed that says ‘No Abdominal Palpation’
C. Palpate the abdomen to determine tumor size
D. Prepare the child for an immediate lumbar puncture
Answer: B
Rationale: Wilms tumor is an encapsulated kidney tumor, and palpation of the mass can
cause the capsule to rupture. Rupture leads to the dissemination of cancer cells throughout
the abdominal cavity and beyond. The nurse must ensure that everyone involved in the
child’s care knows to avoid abdominal palpation to prevent metastasis.
, 4. A 10-year-old is admitted with diabetic ketoacidosis (DKA). Which IV fluid order should the
nurse expect to implement first?
A. Dextrose 5% in water (D5W)
B. 0.9% Normal Saline (NS) bolus
C. D5 0.45% NS with 20 mEq KCL
D. Total Parenteral Nutrition (TPN)
Answer: B
Rationale: The initial priority in treating DKA is to restore intravascular volume and
improve tissue perfusion through fluid resuscitation. Normal Saline (0.9%) is the preferred
isotonic crystalloid for initial volume expansion. Once the blood glucose levels decrease to
a specific threshold, dextrose is added to the fluids to prevent hypoglycemia.
5. Which assessment finding is a late sign of increased intracranial pressure (ICP) in an infant?
A. High-pitched cry
B. Bradycardia and widened pulse pressure
C. Bulging fontanels
D. Irritability and restlessness
Answer: B
Rationale: Cushing’s Triad, which includes bradycardia, hypertension with a widened
pulse pressure, and irregular respirations, is a late sign of increased ICP. Early signs in
Practice – Children’s Health Exam Q&A |
Galen College of Nursing
1. A 4-year-old child with leukemia is hospitalized for chemotherapy. Which laboratory value
should the nurse prioritize to determine the child’s risk for infection?
A. Platelet count
B. Absolute Neutrophil Count (ANC)
C. Hemoglobin level
D. Serum creatinine
Answer: B
Rationale: The Absolute Neutrophil Count (ANC) is the most accurate predictor of a child’s
ability to fight infection. An ANC lower than 500/mm³ indicates a severe risk for life-
threatening infections during chemotherapy. Nurses must monitor this value closely to
implement neutropenic precautions and ensure the safety of the immunocompromised
pediatric patient.
2. The nurse is assessing an infant with suspected Tetralogy of Fallot. Which clinical
manifestation is most characteristic of a ‘tet spell’?
A. Bounding peripheral pulses
B. Bradypnea and hypertension
,C. Increased urine output and lethargy
D. Sudden onset of cyanosis and hyperpnea
Answer: D
Rationale: A hypercyanotic spell, often called a ‘tet spell,’ is characterized by a sudden
increase in cyanosis and rapid, deep respirations. This occurs due to an acute decrease in
pulmonary blood flow and an increase in right-to-left shunting. Placing the infant in a knee-
chest position is the priority intervention to increase systemic vascular resistance and
improve oxygenation.
3. When caring for a child with a suspected Wilms tumor, which action is most important for
the nurse to perform?
A. Measure abdominal girth every 4 hours
B. Place a sign over the bed that says ‘No Abdominal Palpation’
C. Palpate the abdomen to determine tumor size
D. Prepare the child for an immediate lumbar puncture
Answer: B
Rationale: Wilms tumor is an encapsulated kidney tumor, and palpation of the mass can
cause the capsule to rupture. Rupture leads to the dissemination of cancer cells throughout
the abdominal cavity and beyond. The nurse must ensure that everyone involved in the
child’s care knows to avoid abdominal palpation to prevent metastasis.
, 4. A 10-year-old is admitted with diabetic ketoacidosis (DKA). Which IV fluid order should the
nurse expect to implement first?
A. Dextrose 5% in water (D5W)
B. 0.9% Normal Saline (NS) bolus
C. D5 0.45% NS with 20 mEq KCL
D. Total Parenteral Nutrition (TPN)
Answer: B
Rationale: The initial priority in treating DKA is to restore intravascular volume and
improve tissue perfusion through fluid resuscitation. Normal Saline (0.9%) is the preferred
isotonic crystalloid for initial volume expansion. Once the blood glucose levels decrease to
a specific threshold, dextrose is added to the fluids to prevent hypoglycemia.
5. Which assessment finding is a late sign of increased intracranial pressure (ICP) in an infant?
A. High-pitched cry
B. Bradycardia and widened pulse pressure
C. Bulging fontanels
D. Irritability and restlessness
Answer: B
Rationale: Cushing’s Triad, which includes bradycardia, hypertension with a widened
pulse pressure, and irregular respirations, is a late sign of increased ICP. Early signs in
