NUR 3270: NURSING CARE OF
CHILDREN AND FAMILIES - EXAM 3
ADVANCED PRACTICE QUESTIONS
WITH VERIFIED ANSWERS AND
DETAILED EXPLANATIONS
1. A 4-month-old infant is admitted with a diagnosis of Intussusception. The nurse notes the
child just passed a ‘currant jelly’ stool. Which action should the nurse take first?
A. Notify the healthcare provider immediately.
B. Prepare the child for an immediate air enema.
C. Assess the abdomen for a sausage-shaped mass.
D. Document the finding as expected for this diagnosis.
Answer: D
Conceptual Explanation: Currant jelly stools (blood mixed with mucus) are a classic
hallmark finding of intussusception. While it should be documented and the provider
notified, it is a characteristic sign of the condition rather than an acute change in status
requiring immediate intervention beyond standard prep.
2. A nurse is caring for a child with Tetralogy of Fallot who suddenly becomes cyanotic and
dyspneic. Which position should the nurse place the child in?
A. High Fowler’s position
,B. Trendelenburg position
C. Knee-chest position
D. Side-lying position with head elevated
Answer: C
Conceptual Explanation: The knee-chest position increases systemic vascular resistance,
which decreases the right-to-left shunt and improves oxygenation during a ‘Tet spell’.
3. Which clinical manifestation would the nurse expect to find in a 3-week-old infant
diagnosed with Hypertrophic Pyloric Stenosis?
A. Bile-stained emesis after feedings
B. Severe abdominal distension
C. Ribbon-like, foul-smelling stools
D. Projectile vomiting followed by hunger
Answer: D
Conceptual Explanation: In pyloric stenosis, the obstruction is above the bile duct,
resulting in non-bilious projectile vomiting. The infant remains hungry because the food
cannot pass into the duodenum.
4. A child is admitted with suspected Epiglottitis. Which nursing intervention is
contraindicated?
A. Initiating droplet precautions
, B. Obtaining a throat culture
C. Preparing for emergency intubation
D. Administering IV antibiotics as ordered
Answer: B
Conceptual Explanation: Inserting a tongue blade or swab into the throat of a child with
epiglottitis can trigger a laryngospasm and completely obstruct the airway.
5. A child with Sickle Cell Anemia is in a Vaso-occlusive Crisis. What is the priority nursing
goal?
A. Increasing oxygen saturation to 100%
B. Maintaining adequate hydration and pain management
C. Administering iron supplements
D. Restricting physical activity to bedrest
Answer: B
Conceptual Explanation: Hydration helps reduce blood viscosity and prevents further
sickling, while pain management is crucial due to the intense pain caused by tissue
ischemia.
6. Which teaching point is essential for the parents of a child newly diagnosed with Cystic
Fibrosis?
A. Administer pancreatic enzymes 2 hours after meals.
CHILDREN AND FAMILIES - EXAM 3
ADVANCED PRACTICE QUESTIONS
WITH VERIFIED ANSWERS AND
DETAILED EXPLANATIONS
1. A 4-month-old infant is admitted with a diagnosis of Intussusception. The nurse notes the
child just passed a ‘currant jelly’ stool. Which action should the nurse take first?
A. Notify the healthcare provider immediately.
B. Prepare the child for an immediate air enema.
C. Assess the abdomen for a sausage-shaped mass.
D. Document the finding as expected for this diagnosis.
Answer: D
Conceptual Explanation: Currant jelly stools (blood mixed with mucus) are a classic
hallmark finding of intussusception. While it should be documented and the provider
notified, it is a characteristic sign of the condition rather than an acute change in status
requiring immediate intervention beyond standard prep.
2. A nurse is caring for a child with Tetralogy of Fallot who suddenly becomes cyanotic and
dyspneic. Which position should the nurse place the child in?
A. High Fowler’s position
,B. Trendelenburg position
C. Knee-chest position
D. Side-lying position with head elevated
Answer: C
Conceptual Explanation: The knee-chest position increases systemic vascular resistance,
which decreases the right-to-left shunt and improves oxygenation during a ‘Tet spell’.
3. Which clinical manifestation would the nurse expect to find in a 3-week-old infant
diagnosed with Hypertrophic Pyloric Stenosis?
A. Bile-stained emesis after feedings
B. Severe abdominal distension
C. Ribbon-like, foul-smelling stools
D. Projectile vomiting followed by hunger
Answer: D
Conceptual Explanation: In pyloric stenosis, the obstruction is above the bile duct,
resulting in non-bilious projectile vomiting. The infant remains hungry because the food
cannot pass into the duodenum.
4. A child is admitted with suspected Epiglottitis. Which nursing intervention is
contraindicated?
A. Initiating droplet precautions
, B. Obtaining a throat culture
C. Preparing for emergency intubation
D. Administering IV antibiotics as ordered
Answer: B
Conceptual Explanation: Inserting a tongue blade or swab into the throat of a child with
epiglottitis can trigger a laryngospasm and completely obstruct the airway.
5. A child with Sickle Cell Anemia is in a Vaso-occlusive Crisis. What is the priority nursing
goal?
A. Increasing oxygen saturation to 100%
B. Maintaining adequate hydration and pain management
C. Administering iron supplements
D. Restricting physical activity to bedrest
Answer: B
Conceptual Explanation: Hydration helps reduce blood viscosity and prevents further
sickling, while pain management is crucial due to the intense pain caused by tissue
ischemia.
6. Which teaching point is essential for the parents of a child newly diagnosed with Cystic
Fibrosis?
A. Administer pancreatic enzymes 2 hours after meals.
