NUR 254 EXAM 4 — 350 UNIQUE MULTIPLE-CHOICE
QUESTIONS AND ANSWERS WITH DETAILED
RATIONALES LATEST UPDATE 2026
> Course: Concepts of Nursing: The Childbearing/Child Caring Family
> Focus Areas: Pediatric Hematology, Oncology, Neurosensory Disorders,
Maternal-Newborn Nursing, High-Acuity Pediatric Conditions
SECTION 1: HEMATOLOGY — ANEMIA & IRON DEFICIENCY (Questions 1–35)
Question 1
A 9-month-old infant is brought to the clinic with pallor, irritability, and poor
feeding. Laboratory results reveal a hemoglobin of 8.2 g/dL and microcytic,
hypochromic red blood cells. The nurse recognizes these findings are most
consistent with which condition?
A. Sickle cell anemia
B. Iron deficiency anemia
C. Thalassemia major
D. Hemophilia A
Correct Answer: B
1
,Rationale: Iron deficiency anemia is the most common hematologic disorder in
infancy and presents with pallor, irritability, and poor feeding. Microcytic,
hypochromic red blood cells are hallmark laboratory findings. Sickle cell anemia
presents with sickle-shaped cells and vaso-occlusive crises. Thalassemia presents
with target cells and marked hepatosplenomegaly. Hemophilia is a clotting
disorder, not an anemia.
---
Question 2
The nurse is teaching parents about preventing iron deficiency anemia in their
full-term infant. Which instruction should the nurse include?
A. Introduce whole cow's milk at 6 months of age
B. Use iron-fortified commercial formula for the first 12 months
C. Begin iron supplementation at 2 months of age
D. Avoid iron-fortified cereals until 12 months
Correct Answer: B
Rationale: Iron-fortified commercial formula should be given for the first 12
months of life to prevent iron deficiency anemia. Whole cow's milk should not be
introduced until 12 months and should be limited to less than 24 oz per day as it
is a poor source of iron and can cause gastrointestinal bleeding. Iron
supplementation is typically started at 4-6 months for breastfed infants. Iron-
fortified cereals are recommended at 6 months.
---
2
,Question 3
A 7-month-old infant has a hemoglobin level of 6.5 g/dL. Which assessment
finding would the nurse most likely observe?
A. Hyperactivity and flushed skin
B. Lethargy, pallor, and tachycardia
C. Vomiting and watery diarrhea
D. Hypertension and bradycardia
Correct Answer: B
Rationale: Severe anemia (hemoglobin < 7 g/dL) in an infant presents with
lethargy, pallor, tachycardia, and poor feeding. The body attempts to compensate
for decreased oxygen-carrying capacity with increased heart rate. Hyperactivity is
not associated with anemia; fatigue is more common. Vomiting and diarrhea
suggest gastrointestinal illness. Hypotension, not hypertension, may occur in
severe cases.
---
Question 4
A 15-month-old child is diagnosed with iron deficiency anemia. The nurse
anticipates the healthcare provider will prescribe which of the following?
A. Oral ferrous sulfate and dietary teaching
B. Blood transfusion immediately
C. Intramuscular vitamin B12 injections
D. High-dose folic acid supplementation
3
, Correct Answer: A
Rationale: Oral iron supplementation (ferrous sulfate) is the first-line treatment
for iron deficiency anemia. Dietary teaching should include iron-rich foods such as
meats, fortified cereals, and green leafy vegetables. Blood transfusion is reserved
for severe, symptomatic anemia. Vitamin B12 and folic acid deficiencies cause
macrocytic anemias, not iron deficiency.
---
Question 5
The nurse is educating the parents of a child with iron deficiency anemia about
dietary sources of iron. Which food should the nurse recommend as the BEST
source of bioavailable iron?
A. Spinach
B. Fortified bread
C. Red meat
D. Eggs
Correct Answer: C
Rationale: Heme iron from red meat is the most bioavailable form of iron. The
body absorbs heme iron much more efficiently than non-heme iron found in plant
sources like spinach, fortified bread, and eggs. Including vitamin C-rich foods with
meals enhances non-heme iron absorption.
4
QUESTIONS AND ANSWERS WITH DETAILED
RATIONALES LATEST UPDATE 2026
> Course: Concepts of Nursing: The Childbearing/Child Caring Family
> Focus Areas: Pediatric Hematology, Oncology, Neurosensory Disorders,
Maternal-Newborn Nursing, High-Acuity Pediatric Conditions
SECTION 1: HEMATOLOGY — ANEMIA & IRON DEFICIENCY (Questions 1–35)
Question 1
A 9-month-old infant is brought to the clinic with pallor, irritability, and poor
feeding. Laboratory results reveal a hemoglobin of 8.2 g/dL and microcytic,
hypochromic red blood cells. The nurse recognizes these findings are most
consistent with which condition?
A. Sickle cell anemia
B. Iron deficiency anemia
C. Thalassemia major
D. Hemophilia A
Correct Answer: B
1
,Rationale: Iron deficiency anemia is the most common hematologic disorder in
infancy and presents with pallor, irritability, and poor feeding. Microcytic,
hypochromic red blood cells are hallmark laboratory findings. Sickle cell anemia
presents with sickle-shaped cells and vaso-occlusive crises. Thalassemia presents
with target cells and marked hepatosplenomegaly. Hemophilia is a clotting
disorder, not an anemia.
---
Question 2
The nurse is teaching parents about preventing iron deficiency anemia in their
full-term infant. Which instruction should the nurse include?
A. Introduce whole cow's milk at 6 months of age
B. Use iron-fortified commercial formula for the first 12 months
C. Begin iron supplementation at 2 months of age
D. Avoid iron-fortified cereals until 12 months
Correct Answer: B
Rationale: Iron-fortified commercial formula should be given for the first 12
months of life to prevent iron deficiency anemia. Whole cow's milk should not be
introduced until 12 months and should be limited to less than 24 oz per day as it
is a poor source of iron and can cause gastrointestinal bleeding. Iron
supplementation is typically started at 4-6 months for breastfed infants. Iron-
fortified cereals are recommended at 6 months.
---
2
,Question 3
A 7-month-old infant has a hemoglobin level of 6.5 g/dL. Which assessment
finding would the nurse most likely observe?
A. Hyperactivity and flushed skin
B. Lethargy, pallor, and tachycardia
C. Vomiting and watery diarrhea
D. Hypertension and bradycardia
Correct Answer: B
Rationale: Severe anemia (hemoglobin < 7 g/dL) in an infant presents with
lethargy, pallor, tachycardia, and poor feeding. The body attempts to compensate
for decreased oxygen-carrying capacity with increased heart rate. Hyperactivity is
not associated with anemia; fatigue is more common. Vomiting and diarrhea
suggest gastrointestinal illness. Hypotension, not hypertension, may occur in
severe cases.
---
Question 4
A 15-month-old child is diagnosed with iron deficiency anemia. The nurse
anticipates the healthcare provider will prescribe which of the following?
A. Oral ferrous sulfate and dietary teaching
B. Blood transfusion immediately
C. Intramuscular vitamin B12 injections
D. High-dose folic acid supplementation
3
, Correct Answer: A
Rationale: Oral iron supplementation (ferrous sulfate) is the first-line treatment
for iron deficiency anemia. Dietary teaching should include iron-rich foods such as
meats, fortified cereals, and green leafy vegetables. Blood transfusion is reserved
for severe, symptomatic anemia. Vitamin B12 and folic acid deficiencies cause
macrocytic anemias, not iron deficiency.
---
Question 5
The nurse is educating the parents of a child with iron deficiency anemia about
dietary sources of iron. Which food should the nurse recommend as the BEST
source of bioavailable iron?
A. Spinach
B. Fortified bread
C. Red meat
D. Eggs
Correct Answer: C
Rationale: Heme iron from red meat is the most bioavailable form of iron. The
body absorbs heme iron much more efficiently than non-heme iron found in plant
sources like spinach, fortified bread, and eggs. Including vitamin C-rich foods with
meals enhances non-heme iron absorption.
4
