NSG 3600 Exam 3 Actual Exam V2 | NSG 3600 Nursing Practice –
Children’s Health (NSG3600 Exam 3)
1. A 4-year-old child is brought to the emergency department with a barking cough and
inspiratory stridor at rest. Which initial nursing action is the priority?
A. Administer nebulized racemic epinephrine as ordered.
B. Obtain a throat culture to rule out bacterial infection.
C. Encourage the child to drink cold liquids to soothe the throat.
D. Place the child in a supine position for easier assessment.
Answer: A
Rationale: Stridor at rest indicates significant upper airway obstruction, and nebulized
racemic epinephrine is the gold standard for rapid reduction of mucosal edema. Throat
cultures are contraindicated in children with suspected epiglottitis or severe croup as they
can trigger laryngospasm. The child should be kept in a position of comfort, usually upright,
rather than supine to maintain airway patency.
2. A child with cystic fibrosis is being educated on the use of pancrelipase capsules. Which
instruction should the nurse include?
A. Administer the enzymes 30 minutes after every meal.
B. Administer the enzymes before all meals and snacks.
C. Dissolve the beads in a glass of hot milk before giving them.
D. Skip the enzymes if the child is only eating a high-protein snack.
Answer: B
Rationale: Pancreatic enzymes are required to digest fats, proteins, and carbohydrates in a
child with cystic fibrosis. They must be taken before or during all meals and snacks to
ensure they mix with food in the duodenum. These enzymes are deactivated by heat, so
they should never be mixed with hot liquids or food.
3. During a ‘Tet spell’ in an infant with Tetralogy of Fallot, what should the nurse’s immediate
action be?
A. Administer a dose of Digoxin as prescribed.
B. Prepare the infant for immediate endotracheal intubation.
C. Start a bolus of intravenous normal saline.
D. Place the infant in the knee-chest position.
,Answer: D
Rationale: The knee-chest position increases systemic vascular resistance, which helps
force blood from the right ventricle into the pulmonary artery instead of through the septal
defect. This immediate non-pharmacological intervention can rapidly improve oxygenation
during a hypercyanotic spell. Following this, the nurse should provide oxygen and possibly
morphine as ordered.
4. A 10-year-old child with Type 1 Diabetes Mellitus presents with diaphoresis, shakiness, and
tachycardia. What is the most appropriate first action?
A. Administer a subcutaneous dose of regular insulin.
B. Check the child’s blood glucose level immediately.
C. Call the physician to request a metabolic panel.
D. Provide 15 grams of simple carbohydrates, such as orange juice.
Answer: D
Rationale: The child is exhibiting classic signs of hypoglycemia, which requires immediate
treatment with fast-acting carbohydrates. The ‘15-15 rule’ suggests giving 15 grams of
carbs and rechecking the blood sugar in 15 minutes. Delaying treatment to check blood
glucose first is not recommended if the child is symptomatic and the monitor is not
immediately available.
5. Which nursing intervention is crucial for a child admitted with suspected bacterial
meningitis?
A. Keep the room brightly lit to monitor for seizures.
B. Encourage high-volume fluid intake to prevent dehydration.
C. Perform frequent range-of-motion exercises to prevent stiffness.
D. Maintain the child on droplet precautions for at least 24 hours after antibiotics start.
Answer: D
Rationale: Bacterial meningitis is highly contagious via respiratory secretions; therefore,
droplet precautions are mandatory until the child has received effective antibiotic therapy
for 24 hours. Sensory stimuli like bright lights and noise should be minimized to prevent
triggering seizures or discomfort due to photophobia. Fluids may actually be restricted
initially to prevent cerebral edema.
6. An 8-year-old with Sickle Cell Disease is admitted for a vaso-occlusive crisis. Which order
should the nurse prioritize?
A. Administration of meperidine for pain control.
B. Application of cold compresses to painful joints.
, C. Administration of intravenous hydration fluids.
D. Daily assessment of hemoglobin and hematocrit.
Answer: C
Rationale: Hydration is the primary intervention to reduce blood viscosity and prevent
further sickling of red blood cells. Cold compresses are contraindicated as they cause
vasoconstriction, which worsens the crisis. Meperidine is avoided in sickle cell patients due
to the risk of seizures from its metabolite, normeperidine.
7. A mother of a 6-week-old infant reports projectile vomiting after every feeding. On
palpation, the nurse notes an olive-shaped mass in the epigastrium. What does this suggest?
A. Intussusception
B. Hirschsprung Disease
C. Gastroesophageal Reflux Disease
D. Hypertrophic Pyloric Stenosis
Answer: D
Rationale: The classic presentation of hypertrophic pyloric stenosis includes non-bilious
projectile vomiting and a palpable olive-shaped mass in the right upper quadrant. This
condition involves the narrowing of the pyloric sphincter, preventing stomach contents
from entering the duodenum. Surgery, known as a pyloromyotomy, is the definitive
treatment.
8. A toddler is admitted with a diagnosis of intussusception. Which clinical finding is most
characteristic of this condition?
A. Ribbon-like, foul-smelling stools
B. Hard, pebble-like stools
C. Bright red, currant jelly-like stools
D. Frothy, fatty stools that float
Answer: C
Rationale: Intussusception involves the telescoping of one part of the intestine into
another, leading to inflammation and the passage of ‘currant jelly’ stools containing blood
and mucus. This is a surgical or radiologic emergency that requires an air or saline enema
for reduction. If the child passes a normal brown stool, the nurse must report it
immediately as it may indicate spontaneous resolution.
9. A 6-year-old is diagnosed with Acute Glomerulonephritis. Which assessment finding should
the nurse expect?
A. Low blood pressure and polyuria
Children’s Health (NSG3600 Exam 3)
1. A 4-year-old child is brought to the emergency department with a barking cough and
inspiratory stridor at rest. Which initial nursing action is the priority?
A. Administer nebulized racemic epinephrine as ordered.
B. Obtain a throat culture to rule out bacterial infection.
C. Encourage the child to drink cold liquids to soothe the throat.
D. Place the child in a supine position for easier assessment.
Answer: A
Rationale: Stridor at rest indicates significant upper airway obstruction, and nebulized
racemic epinephrine is the gold standard for rapid reduction of mucosal edema. Throat
cultures are contraindicated in children with suspected epiglottitis or severe croup as they
can trigger laryngospasm. The child should be kept in a position of comfort, usually upright,
rather than supine to maintain airway patency.
2. A child with cystic fibrosis is being educated on the use of pancrelipase capsules. Which
instruction should the nurse include?
A. Administer the enzymes 30 minutes after every meal.
B. Administer the enzymes before all meals and snacks.
C. Dissolve the beads in a glass of hot milk before giving them.
D. Skip the enzymes if the child is only eating a high-protein snack.
Answer: B
Rationale: Pancreatic enzymes are required to digest fats, proteins, and carbohydrates in a
child with cystic fibrosis. They must be taken before or during all meals and snacks to
ensure they mix with food in the duodenum. These enzymes are deactivated by heat, so
they should never be mixed with hot liquids or food.
3. During a ‘Tet spell’ in an infant with Tetralogy of Fallot, what should the nurse’s immediate
action be?
A. Administer a dose of Digoxin as prescribed.
B. Prepare the infant for immediate endotracheal intubation.
C. Start a bolus of intravenous normal saline.
D. Place the infant in the knee-chest position.
,Answer: D
Rationale: The knee-chest position increases systemic vascular resistance, which helps
force blood from the right ventricle into the pulmonary artery instead of through the septal
defect. This immediate non-pharmacological intervention can rapidly improve oxygenation
during a hypercyanotic spell. Following this, the nurse should provide oxygen and possibly
morphine as ordered.
4. A 10-year-old child with Type 1 Diabetes Mellitus presents with diaphoresis, shakiness, and
tachycardia. What is the most appropriate first action?
A. Administer a subcutaneous dose of regular insulin.
B. Check the child’s blood glucose level immediately.
C. Call the physician to request a metabolic panel.
D. Provide 15 grams of simple carbohydrates, such as orange juice.
Answer: D
Rationale: The child is exhibiting classic signs of hypoglycemia, which requires immediate
treatment with fast-acting carbohydrates. The ‘15-15 rule’ suggests giving 15 grams of
carbs and rechecking the blood sugar in 15 minutes. Delaying treatment to check blood
glucose first is not recommended if the child is symptomatic and the monitor is not
immediately available.
5. Which nursing intervention is crucial for a child admitted with suspected bacterial
meningitis?
A. Keep the room brightly lit to monitor for seizures.
B. Encourage high-volume fluid intake to prevent dehydration.
C. Perform frequent range-of-motion exercises to prevent stiffness.
D. Maintain the child on droplet precautions for at least 24 hours after antibiotics start.
Answer: D
Rationale: Bacterial meningitis is highly contagious via respiratory secretions; therefore,
droplet precautions are mandatory until the child has received effective antibiotic therapy
for 24 hours. Sensory stimuli like bright lights and noise should be minimized to prevent
triggering seizures or discomfort due to photophobia. Fluids may actually be restricted
initially to prevent cerebral edema.
6. An 8-year-old with Sickle Cell Disease is admitted for a vaso-occlusive crisis. Which order
should the nurse prioritize?
A. Administration of meperidine for pain control.
B. Application of cold compresses to painful joints.
, C. Administration of intravenous hydration fluids.
D. Daily assessment of hemoglobin and hematocrit.
Answer: C
Rationale: Hydration is the primary intervention to reduce blood viscosity and prevent
further sickling of red blood cells. Cold compresses are contraindicated as they cause
vasoconstriction, which worsens the crisis. Meperidine is avoided in sickle cell patients due
to the risk of seizures from its metabolite, normeperidine.
7. A mother of a 6-week-old infant reports projectile vomiting after every feeding. On
palpation, the nurse notes an olive-shaped mass in the epigastrium. What does this suggest?
A. Intussusception
B. Hirschsprung Disease
C. Gastroesophageal Reflux Disease
D. Hypertrophic Pyloric Stenosis
Answer: D
Rationale: The classic presentation of hypertrophic pyloric stenosis includes non-bilious
projectile vomiting and a palpable olive-shaped mass in the right upper quadrant. This
condition involves the narrowing of the pyloric sphincter, preventing stomach contents
from entering the duodenum. Surgery, known as a pyloromyotomy, is the definitive
treatment.
8. A toddler is admitted with a diagnosis of intussusception. Which clinical finding is most
characteristic of this condition?
A. Ribbon-like, foul-smelling stools
B. Hard, pebble-like stools
C. Bright red, currant jelly-like stools
D. Frothy, fatty stools that float
Answer: C
Rationale: Intussusception involves the telescoping of one part of the intestine into
another, leading to inflammation and the passage of ‘currant jelly’ stools containing blood
and mucus. This is a surgical or radiologic emergency that requires an air or saline enema
for reduction. If the child passes a normal brown stool, the nurse must report it
immediately as it may indicate spontaneous resolution.
9. A 6-year-old is diagnosed with Acute Glomerulonephritis. Which assessment finding should
the nurse expect?
A. Low blood pressure and polyuria
