GALEN COLLEGE OF NURSING · COLLEGE OF NURSING
NUR 254 — Child Caring
Families
Exam 4 — Complete
66 NCLEX-Style Practice Questions with Detailed Rationales
Topic Focus: Pediatric Nursing — Comprehensive Review
Exam 4 Edition · September 2026
Table of Contents
1. Instructions for Use 2
2. Hematologic Disorders 2
3. Pediatric Oncology 3
4. Neurologic Disorders 4
,5. Grief, Loss & Child Abuse 5
6. Developmental & Endocrine Disorders 5
7. Musculoskeletal Conditions 6
8. Integumentary Conditions 7
NUR 254 · Galen College of Nursing Page 1
,NUR 254 — CHILD CARING — EXAM 4 INSTRUCTIONS & QUESTIONS
How to Use This Study Guide
Read each stem, choose your answer, then check the rationale directly below it. The correct
option is marked, and each wrong option is explained so you understand why it's wrong — not
just that it is. This guide contains 66 comprehensive NCLEX-style questions covering all
concepts for NUR 254 Child Caring Exam 4.
Hematologic Disorders
1 A nurse is assessing a 4-year-old child. Which hemoglobin level is within the
expected normal range for this age?
A 8.0 g/dL
B 11.0 g/dL
C 15.5 g/dL
D 17.0 g/dL
Why B is correct: Normal Hgb levels for children 1-6 years is 9.5 to 14.0 g/dL. 11.0 g/dL
falls within this normal range.
A — 8.0 g/dL is below normal.
C — 15.5 g/dL is borderline elevated.
D — 17.0 g/dL is elevated.
, 2 A nurse is teaching parents about iron deficiency anemia. Which instruction should
the nurse include?
A "Give iron supplements with Vitamin C on an empty stomach."
B "Give iron supplements with milk to improve absorption."
C "Iron supplements will not stain the teeth."
D "Cow's milk can be introduced at 6 months of age."
Why A is correct: Iron supplements should be given with Vitamin C on an empty stomach
to improve absorption. Milk decreases absorption. Liquid iron can stain teeth, and cow's
milk should not be introduced until 12 months.
B — Milk decreases iron absorption.
C — Liquid iron supplements can stain teeth.
D — Cow's milk should not be introduced until 12 months.
3 A child with sickle cell anemia is in a vaso-occlusive crisis. Which nursing intervention
is a priority?
A Apply cold compresses to painful joints
B Limit oral fluids to prevent fluid overload
C Administer pain medication and maintain hydration
D Place the child on strict bed rest without activity
Why C is correct: Pain management and hydration are priorities during a vaso-occlusive
crisis. Heat, not cold, should be applied. Hydration is critical, and PCA pumps may be used
but require monitoring for respiratory depression.
A — Heat, not cold, should be applied.
B — Hydration is critical, not limited.
D — Activity is not the primary concern.
NUR 254 — Child Caring
Families
Exam 4 — Complete
66 NCLEX-Style Practice Questions with Detailed Rationales
Topic Focus: Pediatric Nursing — Comprehensive Review
Exam 4 Edition · September 2026
Table of Contents
1. Instructions for Use 2
2. Hematologic Disorders 2
3. Pediatric Oncology 3
4. Neurologic Disorders 4
,5. Grief, Loss & Child Abuse 5
6. Developmental & Endocrine Disorders 5
7. Musculoskeletal Conditions 6
8. Integumentary Conditions 7
NUR 254 · Galen College of Nursing Page 1
,NUR 254 — CHILD CARING — EXAM 4 INSTRUCTIONS & QUESTIONS
How to Use This Study Guide
Read each stem, choose your answer, then check the rationale directly below it. The correct
option is marked, and each wrong option is explained so you understand why it's wrong — not
just that it is. This guide contains 66 comprehensive NCLEX-style questions covering all
concepts for NUR 254 Child Caring Exam 4.
Hematologic Disorders
1 A nurse is assessing a 4-year-old child. Which hemoglobin level is within the
expected normal range for this age?
A 8.0 g/dL
B 11.0 g/dL
C 15.5 g/dL
D 17.0 g/dL
Why B is correct: Normal Hgb levels for children 1-6 years is 9.5 to 14.0 g/dL. 11.0 g/dL
falls within this normal range.
A — 8.0 g/dL is below normal.
C — 15.5 g/dL is borderline elevated.
D — 17.0 g/dL is elevated.
, 2 A nurse is teaching parents about iron deficiency anemia. Which instruction should
the nurse include?
A "Give iron supplements with Vitamin C on an empty stomach."
B "Give iron supplements with milk to improve absorption."
C "Iron supplements will not stain the teeth."
D "Cow's milk can be introduced at 6 months of age."
Why A is correct: Iron supplements should be given with Vitamin C on an empty stomach
to improve absorption. Milk decreases absorption. Liquid iron can stain teeth, and cow's
milk should not be introduced until 12 months.
B — Milk decreases iron absorption.
C — Liquid iron supplements can stain teeth.
D — Cow's milk should not be introduced until 12 months.
3 A child with sickle cell anemia is in a vaso-occlusive crisis. Which nursing intervention
is a priority?
A Apply cold compresses to painful joints
B Limit oral fluids to prevent fluid overload
C Administer pain medication and maintain hydration
D Place the child on strict bed rest without activity
Why C is correct: Pain management and hydration are priorities during a vaso-occlusive
crisis. Heat, not cold, should be applied. Hydration is critical, and PCA pumps may be used
but require monitoring for respiratory depression.
A — Heat, not cold, should be applied.
B — Hydration is critical, not limited.
D — Activity is not the primary concern.
