NSG 3600 Exam 4 Pediatrics Review
questions and correct answers with
Rationales/ Galen NSG 3600 Nursing
Practice in Children’s Health Exam 4
MOST RECENT (GRADED A+)
Hematologic Disorders
Sickle Cell Disease
Q1: A child with sickle cell disease presents with severe back pain.
What should the nurse suspect?
Answer: Vaso-occlusive crisis
Rationale: Severe back, chest, or extremity pain is characteristic of a vaso-
occlusive crisis in sickle cell disease. Pain is caused by ischemia from sickled
cells blocking blood flow, leading to tissue hypoxia and infarction. This is
the most common type of sickle cell crisis .
Q2: A child with sickle cell disease has an enlarged spleen and a falling
hematocrit. Which complication is most likely?
Answer: Splenic sequestration crisis
Rationale: Splenic sequestration is characterized by sudden pooling of
blood in the spleen, causing rapid splenic enlargement, abdominal pain,
and a precipitous drop in hemoglobin/hematocrit. This can lead to
hypovolemic shock and requires immediate intervention .
,Q3: Why is penicillin prophylaxis prescribed for children with sickle cell
disease?
Answer: To prevent pneumococcal infections
Rationale: Children with sickle cell disease are at increased risk for
pneumococcal infections due to functional asplenia. Penicillin prophylaxis is
given to prevent these life-threatening infections, as the spleen's ability to
filter encapsulated bacteria is compromised .
Q4: A child with sickle cell disease is receiving hydroxyurea. What is
the purpose of this medication?
Answer: To increase fetal hemoglobin production
Rationale: Hydroxyurea increases the production of fetal hemoglobin
(HbF), which inhibits sickling of red blood cells. This reduces the frequency
of painful vaso-occlusive crises and acute chest syndrome episodes .
Q5: A 5-year-old child with sickle cell disease has O2 sat 92%, RR 13,
HR 100, and is difficult to arouse. The child is on IVF and morphine
sulfate for pain. What action should the nurse take first?
Answer: Administer naloxone to reverse morphine effects
Rationale: The assessment findings (low O2 sat, bradypnea, decreased level
of consciousness) suggest morphine-induced respiratory depression.
Naloxone should be administered immediately to reverse opioid effects.
,The nurse should then apply oxygen, monitor vital signs, and consider
further assessment .
Hemophilia
Q6: A child with hemophilia is learning to walk. What should the nurse
teach the parents?
Answer: "Use soft padding on sharp corners and furniture"
Rationale: Children with hemophilia should have a safe environment to
prevent injury. Soft padding on furniture, avoiding rough play, and
supervision during activities are important safety measures to prevent
bleeding episodes .
Q7: What is the most common type of hemophilia?
Answer: Hemophilia A (factor VIII deficiency)
Rationale: Hemophilia A, caused by a deficiency of factor VIII, is the most
common type of hemophilia, accounting for approximately 80% of cases.
Hemophilia B (factor IX deficiency) is less common .
Q8: What is the long-term complication of repeated joint bleeding in
hemophilia?
Answer: Joint contractures and arthritis
, Rationale: Repeated bleeding into joints (hemarthrosis) causes
inflammation, synovial hypertrophy, and eventually joint destruction,
leading to contractures and arthritis. Early factor replacement is essential to
prevent this complication .
Iron Deficiency Anemia
Q9: What is the recommended screening test for iron deficiency
anemia in children?
Answer: Complete blood count (CBC)
Rationale: A complete blood count with hemoglobin and hematocrit is the
initial screening test for iron deficiency anemia. Hemoglobin
electrophoresis is used to diagnose sickle cell disease and thalassemia .
Q10: When should parents expect to see improvement in hemoglobin
after starting iron supplements?
Answer: Within 4-6 weeks
Rationale: Iron supplementation typically shows improvement in
hemoglobin levels within 4-6 weeks of starting therapy. The parent should
also be taught to expect changes in stool color (dark green or black) .
Neutropenia
Q11: Which of the following is NOT appropriate for a child with
neutropenia?
questions and correct answers with
Rationales/ Galen NSG 3600 Nursing
Practice in Children’s Health Exam 4
MOST RECENT (GRADED A+)
Hematologic Disorders
Sickle Cell Disease
Q1: A child with sickle cell disease presents with severe back pain.
What should the nurse suspect?
Answer: Vaso-occlusive crisis
Rationale: Severe back, chest, or extremity pain is characteristic of a vaso-
occlusive crisis in sickle cell disease. Pain is caused by ischemia from sickled
cells blocking blood flow, leading to tissue hypoxia and infarction. This is
the most common type of sickle cell crisis .
Q2: A child with sickle cell disease has an enlarged spleen and a falling
hematocrit. Which complication is most likely?
Answer: Splenic sequestration crisis
Rationale: Splenic sequestration is characterized by sudden pooling of
blood in the spleen, causing rapid splenic enlargement, abdominal pain,
and a precipitous drop in hemoglobin/hematocrit. This can lead to
hypovolemic shock and requires immediate intervention .
,Q3: Why is penicillin prophylaxis prescribed for children with sickle cell
disease?
Answer: To prevent pneumococcal infections
Rationale: Children with sickle cell disease are at increased risk for
pneumococcal infections due to functional asplenia. Penicillin prophylaxis is
given to prevent these life-threatening infections, as the spleen's ability to
filter encapsulated bacteria is compromised .
Q4: A child with sickle cell disease is receiving hydroxyurea. What is
the purpose of this medication?
Answer: To increase fetal hemoglobin production
Rationale: Hydroxyurea increases the production of fetal hemoglobin
(HbF), which inhibits sickling of red blood cells. This reduces the frequency
of painful vaso-occlusive crises and acute chest syndrome episodes .
Q5: A 5-year-old child with sickle cell disease has O2 sat 92%, RR 13,
HR 100, and is difficult to arouse. The child is on IVF and morphine
sulfate for pain. What action should the nurse take first?
Answer: Administer naloxone to reverse morphine effects
Rationale: The assessment findings (low O2 sat, bradypnea, decreased level
of consciousness) suggest morphine-induced respiratory depression.
Naloxone should be administered immediately to reverse opioid effects.
,The nurse should then apply oxygen, monitor vital signs, and consider
further assessment .
Hemophilia
Q6: A child with hemophilia is learning to walk. What should the nurse
teach the parents?
Answer: "Use soft padding on sharp corners and furniture"
Rationale: Children with hemophilia should have a safe environment to
prevent injury. Soft padding on furniture, avoiding rough play, and
supervision during activities are important safety measures to prevent
bleeding episodes .
Q7: What is the most common type of hemophilia?
Answer: Hemophilia A (factor VIII deficiency)
Rationale: Hemophilia A, caused by a deficiency of factor VIII, is the most
common type of hemophilia, accounting for approximately 80% of cases.
Hemophilia B (factor IX deficiency) is less common .
Q8: What is the long-term complication of repeated joint bleeding in
hemophilia?
Answer: Joint contractures and arthritis
, Rationale: Repeated bleeding into joints (hemarthrosis) causes
inflammation, synovial hypertrophy, and eventually joint destruction,
leading to contractures and arthritis. Early factor replacement is essential to
prevent this complication .
Iron Deficiency Anemia
Q9: What is the recommended screening test for iron deficiency
anemia in children?
Answer: Complete blood count (CBC)
Rationale: A complete blood count with hemoglobin and hematocrit is the
initial screening test for iron deficiency anemia. Hemoglobin
electrophoresis is used to diagnose sickle cell disease and thalassemia .
Q10: When should parents expect to see improvement in hemoglobin
after starting iron supplements?
Answer: Within 4-6 weeks
Rationale: Iron supplementation typically shows improvement in
hemoglobin levels within 4-6 weeks of starting therapy. The parent should
also be taught to expect changes in stool color (dark green or black) .
Neutropenia
Q11: Which of the following is NOT appropriate for a child with
neutropenia?
