NSG 3600 Exam 4 Actual Exam V3 | NSG 3600 Nursing Practice –
Children’s Health (NSG3600 Exam 4)
1. A 7-year-old child with sickle cell anemia is admitted in a vaso-occlusive crisis. Which
nursing intervention should be the highest priority in the plan of care?
A. Managing pain with scheduled opioid analgesics
B. Administering intravenous fluids for hydration
C. Applying cold compresses to the painful joints
D. Encouraging high-impact physical activity
Answer: B
Rationale: Hydration is the priority intervention because it helps reduce the viscosity of
the blood and prevents further sickling of red blood cells. While pain management is
crucial, it follows hydration and oxygenation in the hierarchy of sickle cell crisis
management. Cold compresses are contraindicated as they cause vasoconstriction, which
can worsen the occlusion.
2. A 10-year-old child with Type 1 Diabetes Mellitus plans to participate in a soccer match.
What education should the nurse provide regarding exercise management?
A. Eat a carbohydrate-rich snack before and during the activity
B. Increase the insulin dose immediately before exercise
C. Decrease the carbohydrate intake before the game
D. Exercise only when blood glucose is above 300 mg/dL
Answer: A
Rationale: Exercise increases glucose utilization and can lead to hypoglycemia in children
with Type 1 Diabetes. Consuming extra carbohydrates before and during strenuous activity
helps maintain stable blood glucose levels. Exercising with blood glucose above 300 mg/dL
is dangerous if ketones are present, as it can lead to DKA.
3. Following a spinal fusion for scoliosis, which assessment finding requires immediate
notification of the healthcare provider?
A. Nausea and vomiting after oral intake
B. Pain reported as 6 out of 10 on a numeric scale
C. Inability to move the toes or feel sensation in the feet
D. Slight redness at the surgical incision site
,Answer: C
Rationale: Neurological impairment, such as loss of sensation or movement in the lower
extremities, is a critical complication after spinal surgery. This finding may indicate nerve
damage or spinal cord compression that requires urgent intervention. While pain and
nausea are common post-operative issues, they do not carry the same level of immediate
risk as a neurovascular deficit.
4. The nurse is providing dietary instructions to the parents of a child with Nephrotic
Syndrome. Which recommendation is most appropriate?
A. Low-sodium, moderate-protein diet
B. High-protein, low-potassium diet
C. High-sodium, high-calorie diet
D. Fluid restriction of 500 mL per day
Answer: A
Rationale: Nephrotic Syndrome involves significant edema and protein loss in the urine. A
low-sodium diet helps manage fluid retention, while a moderate protein intake supports
nutrition without overtaxing the kidneys. High-sodium intake would exacerbate the
characteristic edema seen in this condition.
5. An infant is suspected of having hypertrophic pyloric stenosis. Which clinical manifestation
should the nurse expect to observe?
A. Currant jelly-like stools
B. Bile-stained projectile vomiting
C. Abdominal distention and constipation
D. An olive-shaped mass in the epigastrium
Answer: D
Rationale: The hallmark sign of pyloric stenosis is an olive-shaped mass palpable in the
right upper quadrant, along with non-bilious projectile vomiting. This mass represents the
hypertrophied pyloric muscle. Currant jelly stools are associated with intussusception, not
pyloric stenosis.
6. A child with Tetralogy of Fallot is experiencing a ‘tet spell’ or hypercyanotic episode. What
should be the nurse’s first action?
A. Administer 100% oxygen via non-rebreather mask
B. Prepare for immediate administration of morphine
C. Place the child in the knee-chest position
, D. Start an intravenous line for fluid bolus
E. Notify the pediatric cardiologist immediately
F. Perform chest compressions
Answer: C
Rationale: The knee-chest position increases systemic vascular resistance, which helps
reduce the right-to-left shunt and improves pulmonary blood flow. This is the priority non-
invasive action for a hypercyanotic spell. Oxygen and medication are used subsequently if
the position change does not resolve the episode.
7. The nurse is teaching an adolescent how to use a Peak Flow Meter for asthma
management. Which statement by the patient indicates a need for further teaching?
A. I will stand up straight while taking the measurement
B. I will record the lowest of three readings in my diary
C. I should blow into the meter as hard and fast as possible
D. I will reset the meter to zero before each attempt
Answer: B
Rationale: When using a peak flow meter, the patient should record the highest of the
three readings, not the lowest. This value represents the best possible lung function at that
time. Proper technique includes standing up and blowing out forcefully to get an accurate
measurement.
8. A nurse witnesses a child having a generalized tonic-clonic seizure. Which action should the
nurse take first?
A. Turn the child to a side-lying position
B. Restrain the child’s limbs to prevent injury
C. Insert a padded tongue blade into the child’s mouth
D. Administer oral diazepam immediately
Answer: A
Rationale: The priority during a seizure is maintaining a patent airway and preventing
aspiration by turning the child to the side. Nothing should ever be placed in the child’s
mouth during a seizure as it can cause dental damage or airway obstruction. Restraining
the child can lead to bone fractures or muscle injury.
9. A child with leukemia is being discharged after chemotherapy and is neutropenic. Which
instruction is essential for the nurse to include in the teaching?
A. The child should receive the live MMR vaccine next week
Children’s Health (NSG3600 Exam 4)
1. A 7-year-old child with sickle cell anemia is admitted in a vaso-occlusive crisis. Which
nursing intervention should be the highest priority in the plan of care?
A. Managing pain with scheduled opioid analgesics
B. Administering intravenous fluids for hydration
C. Applying cold compresses to the painful joints
D. Encouraging high-impact physical activity
Answer: B
Rationale: Hydration is the priority intervention because it helps reduce the viscosity of
the blood and prevents further sickling of red blood cells. While pain management is
crucial, it follows hydration and oxygenation in the hierarchy of sickle cell crisis
management. Cold compresses are contraindicated as they cause vasoconstriction, which
can worsen the occlusion.
2. A 10-year-old child with Type 1 Diabetes Mellitus plans to participate in a soccer match.
What education should the nurse provide regarding exercise management?
A. Eat a carbohydrate-rich snack before and during the activity
B. Increase the insulin dose immediately before exercise
C. Decrease the carbohydrate intake before the game
D. Exercise only when blood glucose is above 300 mg/dL
Answer: A
Rationale: Exercise increases glucose utilization and can lead to hypoglycemia in children
with Type 1 Diabetes. Consuming extra carbohydrates before and during strenuous activity
helps maintain stable blood glucose levels. Exercising with blood glucose above 300 mg/dL
is dangerous if ketones are present, as it can lead to DKA.
3. Following a spinal fusion for scoliosis, which assessment finding requires immediate
notification of the healthcare provider?
A. Nausea and vomiting after oral intake
B. Pain reported as 6 out of 10 on a numeric scale
C. Inability to move the toes or feel sensation in the feet
D. Slight redness at the surgical incision site
,Answer: C
Rationale: Neurological impairment, such as loss of sensation or movement in the lower
extremities, is a critical complication after spinal surgery. This finding may indicate nerve
damage or spinal cord compression that requires urgent intervention. While pain and
nausea are common post-operative issues, they do not carry the same level of immediate
risk as a neurovascular deficit.
4. The nurse is providing dietary instructions to the parents of a child with Nephrotic
Syndrome. Which recommendation is most appropriate?
A. Low-sodium, moderate-protein diet
B. High-protein, low-potassium diet
C. High-sodium, high-calorie diet
D. Fluid restriction of 500 mL per day
Answer: A
Rationale: Nephrotic Syndrome involves significant edema and protein loss in the urine. A
low-sodium diet helps manage fluid retention, while a moderate protein intake supports
nutrition without overtaxing the kidneys. High-sodium intake would exacerbate the
characteristic edema seen in this condition.
5. An infant is suspected of having hypertrophic pyloric stenosis. Which clinical manifestation
should the nurse expect to observe?
A. Currant jelly-like stools
B. Bile-stained projectile vomiting
C. Abdominal distention and constipation
D. An olive-shaped mass in the epigastrium
Answer: D
Rationale: The hallmark sign of pyloric stenosis is an olive-shaped mass palpable in the
right upper quadrant, along with non-bilious projectile vomiting. This mass represents the
hypertrophied pyloric muscle. Currant jelly stools are associated with intussusception, not
pyloric stenosis.
6. A child with Tetralogy of Fallot is experiencing a ‘tet spell’ or hypercyanotic episode. What
should be the nurse’s first action?
A. Administer 100% oxygen via non-rebreather mask
B. Prepare for immediate administration of morphine
C. Place the child in the knee-chest position
, D. Start an intravenous line for fluid bolus
E. Notify the pediatric cardiologist immediately
F. Perform chest compressions
Answer: C
Rationale: The knee-chest position increases systemic vascular resistance, which helps
reduce the right-to-left shunt and improves pulmonary blood flow. This is the priority non-
invasive action for a hypercyanotic spell. Oxygen and medication are used subsequently if
the position change does not resolve the episode.
7. The nurse is teaching an adolescent how to use a Peak Flow Meter for asthma
management. Which statement by the patient indicates a need for further teaching?
A. I will stand up straight while taking the measurement
B. I will record the lowest of three readings in my diary
C. I should blow into the meter as hard and fast as possible
D. I will reset the meter to zero before each attempt
Answer: B
Rationale: When using a peak flow meter, the patient should record the highest of the
three readings, not the lowest. This value represents the best possible lung function at that
time. Proper technique includes standing up and blowing out forcefully to get an accurate
measurement.
8. A nurse witnesses a child having a generalized tonic-clonic seizure. Which action should the
nurse take first?
A. Turn the child to a side-lying position
B. Restrain the child’s limbs to prevent injury
C. Insert a padded tongue blade into the child’s mouth
D. Administer oral diazepam immediately
Answer: A
Rationale: The priority during a seizure is maintaining a patent airway and preventing
aspiration by turning the child to the side. Nothing should ever be placed in the child’s
mouth during a seizure as it can cause dental damage or airway obstruction. Restraining
the child can lead to bone fractures or muscle injury.
9. A child with leukemia is being discharged after chemotherapy and is neutropenic. Which
instruction is essential for the nurse to include in the teaching?
A. The child should receive the live MMR vaccine next week
