NSG 3600 Exam 4 | Children's Health
COMPREHENSIVE PEDIATRIC NURSING REVIEW (2026/2027) - GALEN COLLEGE
(1) A child with sickle cell anemia is admitted in a vaso-occlusive crisis. Which nursing
intervention is the priority?
A. Administering oxygen at 10 L/min.
B. Managing pain with prescribed opioids and increasing IV fluid intake.
C. Applying cold compresses to the painful joints.
D. Restricting fluids to prevent edema.
CORRECT ANSWER: B
Pediatric Rationale: The priority for vaso-occlusive crisis is hydration (to reduce blood
viscosity) and aggressive pain management. Oxygen is only useful if the child is hypoxic, and
cold compresses cause vasoconstriction, worsening the sickling.
(2) A nurse is caring for a 4-year-old with Wilms' tumor. Which action is most important
for the nurse to avoid?
A. Measuring blood pressure.
B. Palpating the abdomen.
C. Encouraging oral fluids.
D. Checking for hematuria.
CORRECT ANSWER: B
Pediatric Rationale: Palpating the abdomen of a child with Wilms' tumor (nephroblastoma)
can cause the tumor capsule to rupture, leading to the spread of cancer cells throughout the
abdomen.
,(3) A child with Type 1 Diabetes Mellitus presents with deep, rapid respirations and a
fruity breath odor. The nurse recognizes this as:
A. Hypoglycemia
B. Diabetic Ketoacidosis (DKA)
C. Hyperosmolar Hyperglycemic Syndrome
D. Respiratory Alkalosis
CORRECT ANSWER: B
Pediatric Rationale: Kussmaul respirations (deep/rapid) and fruity breath (acetone) are
hallmark signs of DKA, a life-threatening complication of Type 1 DM resulting from ketone
buildup.
(4) A nurse is assessing an infant for developmental dysplasia of the hip (DDH). Which
finding is a positive indicator of DDH?
A. Symmetric gluteal folds.
B. Negative Barlow and Ortolani maneuvers.
C. Asymmetric thigh folds and limited hip abduction.
D. Equal leg length.
CORRECT ANSWER: C
Pediatric Rationale: Asymmetric skin folds on the thighs/buttocks and a limited range of
motion in hip abduction are classic signs of DDH in an infant.
,(5) A school-age child is in a long-leg fiberglass cast. Which assessment finding should
the nurse report to the provider immediately?
A. The child says the cast feels heavy.
B. The toes are pink and warm to the touch.
C. The child reports a 'pins and needles' sensation in the toes.
D. There is a small amount of itching under the cast.
CORRECT ANSWER: C
Pediatric Rationale: Paresthesia (pins and needles) is an early sign of Compartment
Syndrome, a neurovascular emergency. Other signs include pain unrelieved by meds, pallor,
pulselessness, and paralysis.
(6) A 10-month-old infant is admitted with suspected bacterial meningitis. Which
physical sign should the nurse look for?
A. Sunken fontanels.
B. High-pitched cry and bulging fontanels.
C. Slow heart rate and hypertension.
D. Increased appetite and alertness.
CORRECT ANSWER: B
Pediatric Rationale: In infants, increased intracranial pressure from meningitis often
presents as a high-pitched cry, irritability, and bulging fontanels.
, (7) Which is the most common clinical manifestation of Duchenne Muscular Dystrophy
in a toddler?
A. Early attainment of motor milestones.
B. Gower's sign (using hands to 'walk up' the legs to stand).
C. Hyperactive deep tendon reflexes.
D. Spasticity of the upper extremities.
CORRECT ANSWER: B
Pediatric Rationale: Gower's sign is a classic finding in DMD, indicating weakness in the
pelvic girdle muscles.
(8) An adolescent is brought to the ER after an aspirin overdose. Which acid-base
imbalance does the nurse anticipate?
A. Respiratory Acidosis
B. Metabolic Alkalosis
C. Metabolic Acidosis and Respiratory Alkalosis
D. Pure Respiratory Alkalosis
CORRECT ANSWER: C
Pediatric Rationale: Salicylate (aspirin) poisoning typically causes a complex mixed disorder:
initial respiratory alkalosis followed by metabolic acidosis.
COMPREHENSIVE PEDIATRIC NURSING REVIEW (2026/2027) - GALEN COLLEGE
(1) A child with sickle cell anemia is admitted in a vaso-occlusive crisis. Which nursing
intervention is the priority?
A. Administering oxygen at 10 L/min.
B. Managing pain with prescribed opioids and increasing IV fluid intake.
C. Applying cold compresses to the painful joints.
D. Restricting fluids to prevent edema.
CORRECT ANSWER: B
Pediatric Rationale: The priority for vaso-occlusive crisis is hydration (to reduce blood
viscosity) and aggressive pain management. Oxygen is only useful if the child is hypoxic, and
cold compresses cause vasoconstriction, worsening the sickling.
(2) A nurse is caring for a 4-year-old with Wilms' tumor. Which action is most important
for the nurse to avoid?
A. Measuring blood pressure.
B. Palpating the abdomen.
C. Encouraging oral fluids.
D. Checking for hematuria.
CORRECT ANSWER: B
Pediatric Rationale: Palpating the abdomen of a child with Wilms' tumor (nephroblastoma)
can cause the tumor capsule to rupture, leading to the spread of cancer cells throughout the
abdomen.
,(3) A child with Type 1 Diabetes Mellitus presents with deep, rapid respirations and a
fruity breath odor. The nurse recognizes this as:
A. Hypoglycemia
B. Diabetic Ketoacidosis (DKA)
C. Hyperosmolar Hyperglycemic Syndrome
D. Respiratory Alkalosis
CORRECT ANSWER: B
Pediatric Rationale: Kussmaul respirations (deep/rapid) and fruity breath (acetone) are
hallmark signs of DKA, a life-threatening complication of Type 1 DM resulting from ketone
buildup.
(4) A nurse is assessing an infant for developmental dysplasia of the hip (DDH). Which
finding is a positive indicator of DDH?
A. Symmetric gluteal folds.
B. Negative Barlow and Ortolani maneuvers.
C. Asymmetric thigh folds and limited hip abduction.
D. Equal leg length.
CORRECT ANSWER: C
Pediatric Rationale: Asymmetric skin folds on the thighs/buttocks and a limited range of
motion in hip abduction are classic signs of DDH in an infant.
,(5) A school-age child is in a long-leg fiberglass cast. Which assessment finding should
the nurse report to the provider immediately?
A. The child says the cast feels heavy.
B. The toes are pink and warm to the touch.
C. The child reports a 'pins and needles' sensation in the toes.
D. There is a small amount of itching under the cast.
CORRECT ANSWER: C
Pediatric Rationale: Paresthesia (pins and needles) is an early sign of Compartment
Syndrome, a neurovascular emergency. Other signs include pain unrelieved by meds, pallor,
pulselessness, and paralysis.
(6) A 10-month-old infant is admitted with suspected bacterial meningitis. Which
physical sign should the nurse look for?
A. Sunken fontanels.
B. High-pitched cry and bulging fontanels.
C. Slow heart rate and hypertension.
D. Increased appetite and alertness.
CORRECT ANSWER: B
Pediatric Rationale: In infants, increased intracranial pressure from meningitis often
presents as a high-pitched cry, irritability, and bulging fontanels.
, (7) Which is the most common clinical manifestation of Duchenne Muscular Dystrophy
in a toddler?
A. Early attainment of motor milestones.
B. Gower's sign (using hands to 'walk up' the legs to stand).
C. Hyperactive deep tendon reflexes.
D. Spasticity of the upper extremities.
CORRECT ANSWER: B
Pediatric Rationale: Gower's sign is a classic finding in DMD, indicating weakness in the
pelvic girdle muscles.
(8) An adolescent is brought to the ER after an aspirin overdose. Which acid-base
imbalance does the nurse anticipate?
A. Respiratory Acidosis
B. Metabolic Alkalosis
C. Metabolic Acidosis and Respiratory Alkalosis
D. Pure Respiratory Alkalosis
CORRECT ANSWER: C
Pediatric Rationale: Salicylate (aspirin) poisoning typically causes a complex mixed disorder:
initial respiratory alkalosis followed by metabolic acidosis.
