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NSG 3600 EXAM 3
Nursing Practice – Children's Health | 2026 Update | Galen
College of Nursing Comprehensive Review with Complete
Solutions.
Welcome, future pediatric nurses! As you prepare for Exam 3, remember that
pediatric nursing is not just about memorizing diseases; it is about protecting the
vulnerable, recognizing the subtle, and acting with precision. This study guide is
designed to test your clinical judgment and solidify the high-yield concepts from
Units 5 & 6. Read every rationale carefully—they are where the real learning
happens. Let’s get you ready to ace this exam!
PART A: ENDOCRINE & RENAL DISORDERS DRILL (Questions 1–10)
1. A 10-year-old child is admitted to the pediatric unit in Diabetic Ketoacidosis
(DKA). Initial laboratory results reveal a serum potassium level of 2.9 mEq/L.
What is the nurse’s priority action?
A) Administer the regular insulin IV bolus as prescribed.
B) Initiate IV fluid resuscitation with 0.9% normal saline.
C) Hold insulin and prepare to administer intravenous potassium.
D) Administer sodium bicarbonate to correct the metabolic acidosis.
Correct Answer: C) Hold insulin and prepare to administer intravenous
potassium.
Rationale: This is a critical safety concept! In DKA, total body potassium is
depleted due to osmotic diuresis, even if serum levels appear normal or high
initially. Insulin drives potassium back into the cells, which causes a sudden,
potentially fatal drop in serum potassium. If K+ is < 3.3 mEq/L, you MUST hold
insulin and replace potassium first to prevent life-threatening cardiac
dysrhythmias.
,2
2. A nurse is providing discharge teaching to the parents of a 7-year-old newly
diagnosed with Type 1 Diabetes Mellitus. Which statement by the parents
indicates a need for further teaching?
A) "We will give the rapid-acting insulin within 15 minutes before he eats his
meal."
B) "If he gets sick and can't eat, we should hold his insulin so his blood sugar
doesn't drop."
C) "If his blood sugar is below 70 mg/dL, we will give him 4 ounces of juice and
recheck in 15 minutes."
D) "We will check his urine for ketones if his blood sugar is consistently over 250
mg/dL."
Correct Answer: B) "If he gets sick and can't eat, we should hold his insulin so
his blood sugar doesn't drop."
Rationale: During illness, the body releases counterregulatory hormones
(glucagon, cortisol, epinephrine) that increase blood glucose and increase the
risk of DKA. Insulin should never be withheld during sick days; doses may need
adjustment, but basal insulin is required to prevent ketosis. Options A, C, and D
reflect correct management (Rule of 15, rapid-acting timing, sick day ketone
monitoring).
3. A 4-year-old child with Congenital Adrenal Hyperplasia (CAH) is brought to the
emergency department with vomiting, lethargy, and hyponatremia. The nurse
anticipates the immediate administration of which medication?
A) Levothyroxine
B) Desmopressin (DDAVP)
C) Hydrocortisone
D) Methimazole
Correct Answer: C) Hydrocortisone
Rationale: This child is experiencing an adrenal crisis (salt-wasting crisis) due to
CAH (21-hydroxylase deficiency). They lack cortisol and aldosterone. The priority
is IV hydrocortisone to replace the deficient cortisol and suppress the excess
androgen production. Normal saline with dextrose is also given to correct the
hyponatremia and hypoglycemia.
, 3
4. A 5-year-old child is admitted with nephrotic syndrome. Which clinical
manifestation should the nurse expect to find during the initial assessment?
A) Cola-colored urine and hypertension
B) Massive periorbital edema and frothy urine
C) Fever, flank pain, and costovertebral angle tenderness
D) Oliguria and elevated blood urea nitrogen (BUN)
Correct Answer: B) Massive periorbital edema and frothy urine
Rationale: Nephrotic syndrome (primarily Minimal Change Disease in children) is
characterized by massive proteinuria (>3.5g/day), leading to hypoalbuminemia
and severe edema. The edema is often periorbital, dependent, and can cause
ascites. Frothy urine is due to the high protein content. Cola-colored urine and
hypertension are classic for Acute Glomerulonephritis (AGN), not nephrotic
syndrome.
5. The nurse is caring for a child with Acute Glomerulonephritis (AGN). Which
nursing intervention is most appropriate for this child?
A) Encourage a high-protein diet to promote healing.
B) Place the child on strict fluid restriction and a low-sodium diet.
C) Force oral fluids to prevent renal scarring.
D) Teach the parents how to perform clean intermittent catheterization.
Correct Answer: B) Place the child on strict fluid restriction and a low-sodium
diet.
Rationale: AGN (often post-streptococcal) causes fluid retention, hypertension,
and oliguria. The priority intervention is restricting sodium and fluids to prevent
fluid overload and severe hypertension. Forcing fluids is contraindicated due to
the oliguria.
6. A newborn's newborn screening results reveal elevated TSH levels. The nurse
knows that failure to promptly treat this condition will likely result in:
A) Cushingoid features and stunted growth
NSG 3600 EXAM 3
Nursing Practice – Children's Health | 2026 Update | Galen
College of Nursing Comprehensive Review with Complete
Solutions.
Welcome, future pediatric nurses! As you prepare for Exam 3, remember that
pediatric nursing is not just about memorizing diseases; it is about protecting the
vulnerable, recognizing the subtle, and acting with precision. This study guide is
designed to test your clinical judgment and solidify the high-yield concepts from
Units 5 & 6. Read every rationale carefully—they are where the real learning
happens. Let’s get you ready to ace this exam!
PART A: ENDOCRINE & RENAL DISORDERS DRILL (Questions 1–10)
1. A 10-year-old child is admitted to the pediatric unit in Diabetic Ketoacidosis
(DKA). Initial laboratory results reveal a serum potassium level of 2.9 mEq/L.
What is the nurse’s priority action?
A) Administer the regular insulin IV bolus as prescribed.
B) Initiate IV fluid resuscitation with 0.9% normal saline.
C) Hold insulin and prepare to administer intravenous potassium.
D) Administer sodium bicarbonate to correct the metabolic acidosis.
Correct Answer: C) Hold insulin and prepare to administer intravenous
potassium.
Rationale: This is a critical safety concept! In DKA, total body potassium is
depleted due to osmotic diuresis, even if serum levels appear normal or high
initially. Insulin drives potassium back into the cells, which causes a sudden,
potentially fatal drop in serum potassium. If K+ is < 3.3 mEq/L, you MUST hold
insulin and replace potassium first to prevent life-threatening cardiac
dysrhythmias.
,2
2. A nurse is providing discharge teaching to the parents of a 7-year-old newly
diagnosed with Type 1 Diabetes Mellitus. Which statement by the parents
indicates a need for further teaching?
A) "We will give the rapid-acting insulin within 15 minutes before he eats his
meal."
B) "If he gets sick and can't eat, we should hold his insulin so his blood sugar
doesn't drop."
C) "If his blood sugar is below 70 mg/dL, we will give him 4 ounces of juice and
recheck in 15 minutes."
D) "We will check his urine for ketones if his blood sugar is consistently over 250
mg/dL."
Correct Answer: B) "If he gets sick and can't eat, we should hold his insulin so
his blood sugar doesn't drop."
Rationale: During illness, the body releases counterregulatory hormones
(glucagon, cortisol, epinephrine) that increase blood glucose and increase the
risk of DKA. Insulin should never be withheld during sick days; doses may need
adjustment, but basal insulin is required to prevent ketosis. Options A, C, and D
reflect correct management (Rule of 15, rapid-acting timing, sick day ketone
monitoring).
3. A 4-year-old child with Congenital Adrenal Hyperplasia (CAH) is brought to the
emergency department with vomiting, lethargy, and hyponatremia. The nurse
anticipates the immediate administration of which medication?
A) Levothyroxine
B) Desmopressin (DDAVP)
C) Hydrocortisone
D) Methimazole
Correct Answer: C) Hydrocortisone
Rationale: This child is experiencing an adrenal crisis (salt-wasting crisis) due to
CAH (21-hydroxylase deficiency). They lack cortisol and aldosterone. The priority
is IV hydrocortisone to replace the deficient cortisol and suppress the excess
androgen production. Normal saline with dextrose is also given to correct the
hyponatremia and hypoglycemia.
, 3
4. A 5-year-old child is admitted with nephrotic syndrome. Which clinical
manifestation should the nurse expect to find during the initial assessment?
A) Cola-colored urine and hypertension
B) Massive periorbital edema and frothy urine
C) Fever, flank pain, and costovertebral angle tenderness
D) Oliguria and elevated blood urea nitrogen (BUN)
Correct Answer: B) Massive periorbital edema and frothy urine
Rationale: Nephrotic syndrome (primarily Minimal Change Disease in children) is
characterized by massive proteinuria (>3.5g/day), leading to hypoalbuminemia
and severe edema. The edema is often periorbital, dependent, and can cause
ascites. Frothy urine is due to the high protein content. Cola-colored urine and
hypertension are classic for Acute Glomerulonephritis (AGN), not nephrotic
syndrome.
5. The nurse is caring for a child with Acute Glomerulonephritis (AGN). Which
nursing intervention is most appropriate for this child?
A) Encourage a high-protein diet to promote healing.
B) Place the child on strict fluid restriction and a low-sodium diet.
C) Force oral fluids to prevent renal scarring.
D) Teach the parents how to perform clean intermittent catheterization.
Correct Answer: B) Place the child on strict fluid restriction and a low-sodium
diet.
Rationale: AGN (often post-streptococcal) causes fluid retention, hypertension,
and oliguria. The priority intervention is restricting sodium and fluids to prevent
fluid overload and severe hypertension. Forcing fluids is contraindicated due to
the oliguria.
6. A newborn's newborn screening results reveal elevated TSH levels. The nurse
knows that failure to promptly treat this condition will likely result in:
A) Cushingoid features and stunted growth
