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NUR 254 Exam 4
Practice Question Bank
NCLEX-Style Practice Questions with Rationales
Topic Focus: Pediatric Nursing — Pediatric Conditions & Care
Edition 1 · September 2026
Table of Contents
1. Instructions for Use 2
2. Practice Questions with Answers & Rationales — Pediatric Nursing 2
NUR 254 · Galen College of Nursing Page 1
,NUR 254 EXAM 4 PRACTICE GUIDE INSTRUCTIONS & PRACTICE QUESTIONS
How to Use This 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.
Category: Pediatric Nursing — Pediatric Conditions & Care
1 The nurse is caring for a child who has leukemia with a white blood cell (WBC) count
of <1000 mm³. Which of the following should the nurse include in the child's plan of
care?
A Administer prescribed influenza vaccination
B Place the child in a room with a child who has a respiratory infection
C Allow fresh flowers in the child's room
D Encourage the child to play in the hospital playroom
Correct Answer: A A child with leukemia and a WBC count <1000 mm³ is severely
neutropenic and at high risk for infection. Administering the influenza vaccination is
appropriate to help prevent infection. The child should avoid contact with sick individuals,
fresh flowers (which can harbor mold), and public play areas.
B — Placing the child with someone who has a respiratory infection would expose them to
infection.
C — Fresh flowers can harbor mold and bacteria, which are dangerous for
immunocompromised children.
D — The playroom exposes the child to other children who may carry infections.
Tested Concept: Neutropenic precautions in leukemia
Source Concept: The nurse is caring for a child who has leukemia with a white blood cell (WBC) count
of < 1000 mm. Which of the following should the nurse include in the child's plan of care? Administer
prescribed influenza vaccination
,2 The nurse is providing a teaching session to the health care staff regarding
osteosarcoma. Which of the following statements by an attendee indicates a need
for additional teaching?
A "In the early stage, the symptoms of this disease are usually attributed to normal
growing pains."
B "Osteosarcoma most commonly affects the long bones of the extremities."
C "Osteosarcoma is the most common type of bone cancer in children."
D "Pain and swelling are common presenting symptoms of osteosarcoma."
Correct Answer: A This statement indicates a need for additional teaching because
symptoms of osteosarcoma should not be attributed to normal growing pains. Early
diagnosis is important, and persistent pain, swelling, or a mass should be evaluated.
B — This is correct; osteosarcoma commonly affects the long bones.
C — This is correct; osteosarcoma is the most common bone cancer in children.
D — This is correct; pain and swelling are common symptoms.
Tested Concept: Osteosarcoma teaching
Source Concept: "In the early stage, the symptoms of this disease are usually attributed to normal
growing pains." — indicates need for additional teaching
, 3 The nurse is caring for a child who is suspected of having a Wilms' tumor. Which of
the following actions by the nurse indicates the need for additional training?
A Palpating the child's abdomen
B Monitoring the child's blood pressure
C Assessing for hematuria
D Preparing the child for surgery
Correct Answer: A Palpating the abdomen of a child with a suspected Wilms' tumor is
contraindicated because it can cause rupture of the tumor and spread of malignant cells.
The abdomen should not be palpated.
B — Monitoring blood pressure is appropriate as Wilms' tumor can cause hypertension.
C — Assessing for hematuria is appropriate.
D — Preparing for surgery is appropriate.
Tested Concept: Wilms' tumor — contraindicated abdominal palpation
Source Concept: The nurse is caring for a child who is suspected of having a Wilm's tumor. Which of
the following actions by the nurse indicates the need for additional training? Palpating the child's
abdomen
NUR 254 Exam 4
Practice Question Bank
NCLEX-Style Practice Questions with Rationales
Topic Focus: Pediatric Nursing — Pediatric Conditions & Care
Edition 1 · September 2026
Table of Contents
1. Instructions for Use 2
2. Practice Questions with Answers & Rationales — Pediatric Nursing 2
NUR 254 · Galen College of Nursing Page 1
,NUR 254 EXAM 4 PRACTICE GUIDE INSTRUCTIONS & PRACTICE QUESTIONS
How to Use This 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.
Category: Pediatric Nursing — Pediatric Conditions & Care
1 The nurse is caring for a child who has leukemia with a white blood cell (WBC) count
of <1000 mm³. Which of the following should the nurse include in the child's plan of
care?
A Administer prescribed influenza vaccination
B Place the child in a room with a child who has a respiratory infection
C Allow fresh flowers in the child's room
D Encourage the child to play in the hospital playroom
Correct Answer: A A child with leukemia and a WBC count <1000 mm³ is severely
neutropenic and at high risk for infection. Administering the influenza vaccination is
appropriate to help prevent infection. The child should avoid contact with sick individuals,
fresh flowers (which can harbor mold), and public play areas.
B — Placing the child with someone who has a respiratory infection would expose them to
infection.
C — Fresh flowers can harbor mold and bacteria, which are dangerous for
immunocompromised children.
D — The playroom exposes the child to other children who may carry infections.
Tested Concept: Neutropenic precautions in leukemia
Source Concept: The nurse is caring for a child who has leukemia with a white blood cell (WBC) count
of < 1000 mm. Which of the following should the nurse include in the child's plan of care? Administer
prescribed influenza vaccination
,2 The nurse is providing a teaching session to the health care staff regarding
osteosarcoma. Which of the following statements by an attendee indicates a need
for additional teaching?
A "In the early stage, the symptoms of this disease are usually attributed to normal
growing pains."
B "Osteosarcoma most commonly affects the long bones of the extremities."
C "Osteosarcoma is the most common type of bone cancer in children."
D "Pain and swelling are common presenting symptoms of osteosarcoma."
Correct Answer: A This statement indicates a need for additional teaching because
symptoms of osteosarcoma should not be attributed to normal growing pains. Early
diagnosis is important, and persistent pain, swelling, or a mass should be evaluated.
B — This is correct; osteosarcoma commonly affects the long bones.
C — This is correct; osteosarcoma is the most common bone cancer in children.
D — This is correct; pain and swelling are common symptoms.
Tested Concept: Osteosarcoma teaching
Source Concept: "In the early stage, the symptoms of this disease are usually attributed to normal
growing pains." — indicates need for additional teaching
, 3 The nurse is caring for a child who is suspected of having a Wilms' tumor. Which of
the following actions by the nurse indicates the need for additional training?
A Palpating the child's abdomen
B Monitoring the child's blood pressure
C Assessing for hematuria
D Preparing the child for surgery
Correct Answer: A Palpating the abdomen of a child with a suspected Wilms' tumor is
contraindicated because it can cause rupture of the tumor and spread of malignant cells.
The abdomen should not be palpated.
B — Monitoring blood pressure is appropriate as Wilms' tumor can cause hypertension.
C — Assessing for hematuria is appropriate.
D — Preparing for surgery is appropriate.
Tested Concept: Wilms' tumor — contraindicated abdominal palpation
Source Concept: The nurse is caring for a child who is suspected of having a Wilm's tumor. Which of
the following actions by the nurse indicates the need for additional training? Palpating the child's
abdomen
