NUR 254 - Exam 3 - Galen College of Nursing - 2026/2027 Actual Exam - Correct Detailed Answers
NUR 254 - Exam 3
Galen College of Nursing
2026/2027 Actual Exam - Questions with Correct Detailed Answers
Exam Format: 80 multiple-choice questions across seven integrated modules of pediatric nursing - Respiratory and Cardiac;
Gastrointestinal and Genitourinary; Neurological and Musculoskeletal; Hematology, Oncology, and Immunology; Endocrine
and Metabolic; Infectious Diseases and Immunizations; and Pediatric Emergencies and Critical Care. Each question has four
options (A-D) with one best answer. Cognitive distribution: 25% recall, 55% application, 20% analysis. Approximately 80%
of items are scenario-based, integrating clinical judgment (NCLEX Next Generation), ABC prioritization, family-centered
care, and developmental considerations. Each answer includes a detailed Galen-level rationale addressing pathophysiology,
assessment, interventions, and nursing principles.
Section 1: Pediatric Respiratory and Cardiac Disorders
Topics: Asthma, Bronchiolitis, Pneumonia, Croup, RSV, Congenital Heart Defects, Kawasaki Disease, Rheumatic Fever
(Q1-Q18)
Q1. A 5-year-old child is brought to the emergency department with audible wheezing, suprasternal retractions,
nasal flaring, and a SpO2 of 90% on room air. The child is speaking in short phrases and has a respiratory rate
of 42. Which finding most strongly indicates impending respiratory failure rather than simple respiratory
distress?
A. Wheezing audible without stethoscope
B. Decreased level of consciousness, grunting, and irregular respiratory pattern [CORRECT]
C. Nasal flaring and suprasternal retractions
D. SpO2 of 90% on room air
Correct Answer: B
Rationale: Decreased level of consciousness, grunting, and irregular respirations signal impending respiratory failure - the
child is tiring and CO2 retention is causing neurological depression, which requires immediate escalation to positive pressure
ventilation. Wheezing, nasal flaring, retractions, and SpO2 of 90% all indicate moderate respiratory distress but are not by
themselves failure markers; intervention is needed but the child is still compensating.
Q2. A 7-year-old with asthma is being discharged home. The nurse teaches the parents about the difference
between a rescue inhaler (albuterol) and a controller medication (fluticasone). Which statement by the parent
indicates teaching was effective?
A. "I will give the fluticasone every day even when my child is well to prevent attacks." [CORRECT]
B. "I will use albuterol daily to prevent asthma symptoms."
C. "I will stop the fluticasone once my child feels better."
D. "I will give both medications only when my child is wheezing."
Correct Answer: A
Rationale: Controller medications such as inhaled corticosteroids (fluticasone) must be taken daily, even when asymptomatic,
because they reduce airway inflammation and prevent exacerbations over time. Albuterol is a rescue bronchodilator used only
for acute symptoms, not daily prevention. Stopping the controller when symptoms improve leads to rebound inflammation, and
using both only during wheezing fails to address the underlying inflammatory process.
Pediatric Nursing - Maternal-Child Nursing Program Page 1
,NUR 254 - Exam 3 - Galen College of Nursing - 2026/2027 Actual Exam - Correct Detailed Answers
Q3. A 10-year-old with asthma uses a peak flow meter at home. The child's personal best is 400 L/min. This
morning the reading is 280 L/min, which corresponds to 70% of personal best and falls in the yellow zone of the
asthma action plan. Which action is most appropriate per the asthma action plan?
A. Take the rescue inhaler (albuterol) and continue normal activities
B. Take the rescue inhaler (albuterol), monitor closely, and contact the provider if no improvement
[CORRECT]
C. Call 911 immediately
D. Skip the rescue inhaler and increase the controller medication dose
Correct Answer: B
Rationale: The yellow zone (50-79% of personal best) signals caution: the child should take the rescue inhaler (albuterol),
monitor symptoms closely, and contact the provider if symptoms do not improve or peak flow drops further. Calling 911 is
reserved for the red zone (below 50% with severe symptoms). Simply continuing normal activities risks deterioration, and
increasing the controller dose acutely will not relieve bronchospasm.
Q4. A 4-month-old infant is admitted with bronchiolitis caused by RSV. The infant has copious nasal secretions,
mild intercostal retractions, SpO2 of 92%, and is taking only 1 oz of formula per feeding. Which nursing
intervention is the priority?
A. Administer oral albuterol every 4 hours
B. Perform nasal suctioning before feedings and maintain hydration [CORRECT]
C. Start broad-spectrum antibiotics
D. Restrict fluids to prevent fluid overload
Correct Answer: B
Rationale: For bronchiolitis, the priority interventions are airway clearance (nasal suctioning before feeds to improve breathing
and feeding) and hydration support; the disease is viral so antibiotics are not indicated. Albuterol is generally ineffective in
typical RSV bronchiolitis and is reserved for those with a strong asthma component. Fluid restriction would worsen dehydration
risk in an infant already feeding poorly.
Q5. A 6-month-old infant was born at 30 weeks gestation and has chronic lung disease. The parent asks why the
infant receives Synagis (palivizumab) injections monthly during RSV season. Which response by the nurse is
most accurate?
A. Synagis is a vaccine that gives the baby lifelong immunity to RSV
B. Synagis provides passive immunity with RSV-specific monoclonal antibodies each month to prevent
severe RSV infection in high-risk infants [CORRECT]
C. Synagis treats active RSV infection once symptoms start
D. Synagis replaces routine childhood immunizations during RSV season
Correct Answer: B
Rationale: Palivizumab (Synagis) is a monoclonal antibody providing passive immunity each month for high-risk infants
(premature, chronic lung disease, hemodynamically significant CHD); it prevents severe RSV disease but is not a vaccine and
does not confer long-term immunity. It is prophylactic, not therapeutic, and does not replace routine immunizations. The 2023
ACIP now recommends nirsevimab (Beyfortus), a long-acting monoclonal, for broader infant protection.
Pediatric Nursing - Maternal-Child Nursing Program Page 2
, NUR 254 - Exam 3 - Galen College of Nursing - 2026/2027 Actual Exam - Correct Detailed Answers
Q6. A 2-year-old is brought to the ED at 2 AM with a barking cough, inspiratory stridor at rest, mild
suprasternal retractions, and a hoarse cry. Temperature is 100.4°F (38°C). The child has had cold symptoms for
2 days. Which condition and intervention are most likely?
A. Epiglottitis - prepare for intubation and keep child upright
B. Laryngotracheobronchitis (croup) - administer nebulized racemic epinephrine and oral/IV
dexamethasone [CORRECT]
C. Bacterial tracheitis - start IV antibiotics immediately
D. Foreign body aspiration - perform back blows
Correct Answer: B
Rationale: Barking cough, inspiratory stridor, hoarse cry, and viral prodrome are classic for laryngotracheobronchitis (croup);
treatment includes nebulized racemic epinephrine for airway edema and dexamethasone for inflammation. Epiglottitis presents
with drooling, tripod posture, no cough, and high fever; bacterial tracheitis has high fever and toxic appearance with thick
secretions; foreign body aspiration lacks the viral prodrome.
Q7. A 3-year-old presents with sudden high fever (103.5°F), drooling, tripod sitting position, muffled voice, and
no cough. The nurse suspects epiglottitis. Which action is the priority before any diagnostic procedure?
A. Inspect the throat with a tongue blade and obtain throat culture
B. Keep the child upright on parent's lap, avoid agitation, and notify anesthesia/ENT for airway evaluation
[CORRECT]
C. Administer acetaminophen and oral fluids
D. Obtain a lateral neck X-ray in the radiology department
Correct Answer: B
Rationale: Epiglottitis is a true airway emergency; agitation can precipitate complete obstruction, so the child should remain
upright on the parent's lap while anesthesia/ENT prepare for controlled airway evaluation in the OR. Inspecting the throat with a
tongue blade can trigger laryngospasm and is absolutely contraindicated. X-ray, while diagnostic, should only be done if the
child is stable and accompanied by staff capable of managing the airway.
Q8. A 4-year-old with bacterial pneumonia is prescribed oral amoxicillin 90 mg/kg/day divided every 12 hours.
The child weighs 33 lb (15 kg). The suspension available is 400 mg/5 mL. How many mL per dose should the
nurse administer?
A. 7.7 mL per dose
B. 8.4 mL per dose (90 x = 675 mg/dose; 675 x = 8.4 mL) [CORRECT]
C. 16.9 mL per dose
D. 4.2 mL per dose
Correct Answer: B
Rationale: Calculation: 90 mg/kg/day x 15 kg = 1350 mg/day; divided q12h = 675 mg per dose. Concentration is 400 mg/5 mL =
80 mg/mL. Dose volume = = 8.4 mL. The other options reflect errors in dividing the daily dose, misapplying the
concentration, or omitting the divide-by-2 step.
Pediatric Nursing - Maternal-Child Nursing Program Page 3
NUR 254 - Exam 3
Galen College of Nursing
2026/2027 Actual Exam - Questions with Correct Detailed Answers
Exam Format: 80 multiple-choice questions across seven integrated modules of pediatric nursing - Respiratory and Cardiac;
Gastrointestinal and Genitourinary; Neurological and Musculoskeletal; Hematology, Oncology, and Immunology; Endocrine
and Metabolic; Infectious Diseases and Immunizations; and Pediatric Emergencies and Critical Care. Each question has four
options (A-D) with one best answer. Cognitive distribution: 25% recall, 55% application, 20% analysis. Approximately 80%
of items are scenario-based, integrating clinical judgment (NCLEX Next Generation), ABC prioritization, family-centered
care, and developmental considerations. Each answer includes a detailed Galen-level rationale addressing pathophysiology,
assessment, interventions, and nursing principles.
Section 1: Pediatric Respiratory and Cardiac Disorders
Topics: Asthma, Bronchiolitis, Pneumonia, Croup, RSV, Congenital Heart Defects, Kawasaki Disease, Rheumatic Fever
(Q1-Q18)
Q1. A 5-year-old child is brought to the emergency department with audible wheezing, suprasternal retractions,
nasal flaring, and a SpO2 of 90% on room air. The child is speaking in short phrases and has a respiratory rate
of 42. Which finding most strongly indicates impending respiratory failure rather than simple respiratory
distress?
A. Wheezing audible without stethoscope
B. Decreased level of consciousness, grunting, and irregular respiratory pattern [CORRECT]
C. Nasal flaring and suprasternal retractions
D. SpO2 of 90% on room air
Correct Answer: B
Rationale: Decreased level of consciousness, grunting, and irregular respirations signal impending respiratory failure - the
child is tiring and CO2 retention is causing neurological depression, which requires immediate escalation to positive pressure
ventilation. Wheezing, nasal flaring, retractions, and SpO2 of 90% all indicate moderate respiratory distress but are not by
themselves failure markers; intervention is needed but the child is still compensating.
Q2. A 7-year-old with asthma is being discharged home. The nurse teaches the parents about the difference
between a rescue inhaler (albuterol) and a controller medication (fluticasone). Which statement by the parent
indicates teaching was effective?
A. "I will give the fluticasone every day even when my child is well to prevent attacks." [CORRECT]
B. "I will use albuterol daily to prevent asthma symptoms."
C. "I will stop the fluticasone once my child feels better."
D. "I will give both medications only when my child is wheezing."
Correct Answer: A
Rationale: Controller medications such as inhaled corticosteroids (fluticasone) must be taken daily, even when asymptomatic,
because they reduce airway inflammation and prevent exacerbations over time. Albuterol is a rescue bronchodilator used only
for acute symptoms, not daily prevention. Stopping the controller when symptoms improve leads to rebound inflammation, and
using both only during wheezing fails to address the underlying inflammatory process.
Pediatric Nursing - Maternal-Child Nursing Program Page 1
,NUR 254 - Exam 3 - Galen College of Nursing - 2026/2027 Actual Exam - Correct Detailed Answers
Q3. A 10-year-old with asthma uses a peak flow meter at home. The child's personal best is 400 L/min. This
morning the reading is 280 L/min, which corresponds to 70% of personal best and falls in the yellow zone of the
asthma action plan. Which action is most appropriate per the asthma action plan?
A. Take the rescue inhaler (albuterol) and continue normal activities
B. Take the rescue inhaler (albuterol), monitor closely, and contact the provider if no improvement
[CORRECT]
C. Call 911 immediately
D. Skip the rescue inhaler and increase the controller medication dose
Correct Answer: B
Rationale: The yellow zone (50-79% of personal best) signals caution: the child should take the rescue inhaler (albuterol),
monitor symptoms closely, and contact the provider if symptoms do not improve or peak flow drops further. Calling 911 is
reserved for the red zone (below 50% with severe symptoms). Simply continuing normal activities risks deterioration, and
increasing the controller dose acutely will not relieve bronchospasm.
Q4. A 4-month-old infant is admitted with bronchiolitis caused by RSV. The infant has copious nasal secretions,
mild intercostal retractions, SpO2 of 92%, and is taking only 1 oz of formula per feeding. Which nursing
intervention is the priority?
A. Administer oral albuterol every 4 hours
B. Perform nasal suctioning before feedings and maintain hydration [CORRECT]
C. Start broad-spectrum antibiotics
D. Restrict fluids to prevent fluid overload
Correct Answer: B
Rationale: For bronchiolitis, the priority interventions are airway clearance (nasal suctioning before feeds to improve breathing
and feeding) and hydration support; the disease is viral so antibiotics are not indicated. Albuterol is generally ineffective in
typical RSV bronchiolitis and is reserved for those with a strong asthma component. Fluid restriction would worsen dehydration
risk in an infant already feeding poorly.
Q5. A 6-month-old infant was born at 30 weeks gestation and has chronic lung disease. The parent asks why the
infant receives Synagis (palivizumab) injections monthly during RSV season. Which response by the nurse is
most accurate?
A. Synagis is a vaccine that gives the baby lifelong immunity to RSV
B. Synagis provides passive immunity with RSV-specific monoclonal antibodies each month to prevent
severe RSV infection in high-risk infants [CORRECT]
C. Synagis treats active RSV infection once symptoms start
D. Synagis replaces routine childhood immunizations during RSV season
Correct Answer: B
Rationale: Palivizumab (Synagis) is a monoclonal antibody providing passive immunity each month for high-risk infants
(premature, chronic lung disease, hemodynamically significant CHD); it prevents severe RSV disease but is not a vaccine and
does not confer long-term immunity. It is prophylactic, not therapeutic, and does not replace routine immunizations. The 2023
ACIP now recommends nirsevimab (Beyfortus), a long-acting monoclonal, for broader infant protection.
Pediatric Nursing - Maternal-Child Nursing Program Page 2
, NUR 254 - Exam 3 - Galen College of Nursing - 2026/2027 Actual Exam - Correct Detailed Answers
Q6. A 2-year-old is brought to the ED at 2 AM with a barking cough, inspiratory stridor at rest, mild
suprasternal retractions, and a hoarse cry. Temperature is 100.4°F (38°C). The child has had cold symptoms for
2 days. Which condition and intervention are most likely?
A. Epiglottitis - prepare for intubation and keep child upright
B. Laryngotracheobronchitis (croup) - administer nebulized racemic epinephrine and oral/IV
dexamethasone [CORRECT]
C. Bacterial tracheitis - start IV antibiotics immediately
D. Foreign body aspiration - perform back blows
Correct Answer: B
Rationale: Barking cough, inspiratory stridor, hoarse cry, and viral prodrome are classic for laryngotracheobronchitis (croup);
treatment includes nebulized racemic epinephrine for airway edema and dexamethasone for inflammation. Epiglottitis presents
with drooling, tripod posture, no cough, and high fever; bacterial tracheitis has high fever and toxic appearance with thick
secretions; foreign body aspiration lacks the viral prodrome.
Q7. A 3-year-old presents with sudden high fever (103.5°F), drooling, tripod sitting position, muffled voice, and
no cough. The nurse suspects epiglottitis. Which action is the priority before any diagnostic procedure?
A. Inspect the throat with a tongue blade and obtain throat culture
B. Keep the child upright on parent's lap, avoid agitation, and notify anesthesia/ENT for airway evaluation
[CORRECT]
C. Administer acetaminophen and oral fluids
D. Obtain a lateral neck X-ray in the radiology department
Correct Answer: B
Rationale: Epiglottitis is a true airway emergency; agitation can precipitate complete obstruction, so the child should remain
upright on the parent's lap while anesthesia/ENT prepare for controlled airway evaluation in the OR. Inspecting the throat with a
tongue blade can trigger laryngospasm and is absolutely contraindicated. X-ray, while diagnostic, should only be done if the
child is stable and accompanied by staff capable of managing the airway.
Q8. A 4-year-old with bacterial pneumonia is prescribed oral amoxicillin 90 mg/kg/day divided every 12 hours.
The child weighs 33 lb (15 kg). The suspension available is 400 mg/5 mL. How many mL per dose should the
nurse administer?
A. 7.7 mL per dose
B. 8.4 mL per dose (90 x = 675 mg/dose; 675 x = 8.4 mL) [CORRECT]
C. 16.9 mL per dose
D. 4.2 mL per dose
Correct Answer: B
Rationale: Calculation: 90 mg/kg/day x 15 kg = 1350 mg/day; divided q12h = 675 mg per dose. Concentration is 400 mg/5 mL =
80 mg/mL. Dose volume = = 8.4 mL. The other options reflect errors in dividing the daily dose, misapplying the
concentration, or omitting the divide-by-2 step.
Pediatric Nursing - Maternal-Child Nursing Program Page 3
