NSG434 Exam 3 Actual Exam Style V3 |
NSG 434 Nursing Care of Children | Grand
Canyon University
1. A 4-year-old child is diagnosed with Acute Lymphoblastic Leukemia (ALL). Which laboratory
result should the nurse prioritize as the most significant risk for infection?
A. Platelet count of 150,000/mm3
B. Hemoglobin level of 10 g/dL
C. Absolute Neutrophil Count (ANC) of 450/mm3
D. White blood cell count of 12,000/mm3
Answer: C
Rationale: An Absolute Neutrophil Count (ANC) below 500/mm3 indicates severe
neutropenia and a high risk for life-threatening infection. In pediatric oncology, monitoring
the ANC is critical for determining the safety of administering chemotherapy and the need
for protective isolation. The other values provided are within or near normal ranges and do
not represent the same level of acute risk as the low ANC.
2. The nurse is caring for an infant suspected of having Hirschsprung disease. Which clinical
manifestation is most characteristic of this disorder?
A. Failure to pass meconium within the first 24 to 48 hours
B. Currant jelly-like stools
,C. Projectile vomiting after feedings
D. Palpable olive-shaped mass in the epigastrium
Answer: A
Rationale: Hirschsprung disease is characterized by the absence of ganglion cells in the
colon, preventing peristalsis. The primary sign in newborns is the failure to pass meconium
within the first 48 hours of life due to functional obstruction. Projectile vomiting and olive-
shaped masses are associated with pyloric stenosis, while currant jelly stools are classic for
intussusception.
3. When palpating the abdomen of a child with a suspected Wilms tumor, what is the most
important nursing intervention?
A. Avoid any further palpation of the abdomen
B. Palpate deeply to determine the size of the mass
C. Check for rebound tenderness in the lower quadrants
D. Palpate only when the child is in a prone position
Answer: A
Rationale: Wilms tumor, or nephroblastoma, is an encapsulated tumor of the kidney.
Vigorous or even routine palpation of the abdomen can cause the capsule to rupture,
leading to the seeding of cancer cells throughout the peritoneal cavity. Nursing care must
focus on placing a ‘Do Not Palpate’ sign at the bedside to protect the patient from accidental
injury.
, 4. A 10-year-old child with Juvenile Idiopathic Arthritis (JIA) is experiencing significant
morning stiffness. Which intervention should the nurse recommend to the parents?
A. Apply cold packs to joints immediately upon awakening
B. Perform vigorous weight-bearing exercises before breakfast
C. Maintain complete bed rest until the pain subsides
D. Encourage a warm bath or shower every morning
Answer: D
Rationale: Morning stiffness in JIA is effectively managed by the application of heat to
increase circulation and joint flexibility. A warm bath or shower helps loosen stiff joints
and reduces discomfort, facilitating better movement throughout the day. Promoting
mobility is essential for these children, as prolonged inactivity actually increases stiffness
and joint contractures.
5. An infant with pyloric stenosis is scheduled for a pyloromyotomy. Which acid-base
imbalance is the nurse most likely to observe in this patient?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Respiratory acidosis
D. Metabolic alkalosis
Answer: D
NSG 434 Nursing Care of Children | Grand
Canyon University
1. A 4-year-old child is diagnosed with Acute Lymphoblastic Leukemia (ALL). Which laboratory
result should the nurse prioritize as the most significant risk for infection?
A. Platelet count of 150,000/mm3
B. Hemoglobin level of 10 g/dL
C. Absolute Neutrophil Count (ANC) of 450/mm3
D. White blood cell count of 12,000/mm3
Answer: C
Rationale: An Absolute Neutrophil Count (ANC) below 500/mm3 indicates severe
neutropenia and a high risk for life-threatening infection. In pediatric oncology, monitoring
the ANC is critical for determining the safety of administering chemotherapy and the need
for protective isolation. The other values provided are within or near normal ranges and do
not represent the same level of acute risk as the low ANC.
2. The nurse is caring for an infant suspected of having Hirschsprung disease. Which clinical
manifestation is most characteristic of this disorder?
A. Failure to pass meconium within the first 24 to 48 hours
B. Currant jelly-like stools
,C. Projectile vomiting after feedings
D. Palpable olive-shaped mass in the epigastrium
Answer: A
Rationale: Hirschsprung disease is characterized by the absence of ganglion cells in the
colon, preventing peristalsis. The primary sign in newborns is the failure to pass meconium
within the first 48 hours of life due to functional obstruction. Projectile vomiting and olive-
shaped masses are associated with pyloric stenosis, while currant jelly stools are classic for
intussusception.
3. When palpating the abdomen of a child with a suspected Wilms tumor, what is the most
important nursing intervention?
A. Avoid any further palpation of the abdomen
B. Palpate deeply to determine the size of the mass
C. Check for rebound tenderness in the lower quadrants
D. Palpate only when the child is in a prone position
Answer: A
Rationale: Wilms tumor, or nephroblastoma, is an encapsulated tumor of the kidney.
Vigorous or even routine palpation of the abdomen can cause the capsule to rupture,
leading to the seeding of cancer cells throughout the peritoneal cavity. Nursing care must
focus on placing a ‘Do Not Palpate’ sign at the bedside to protect the patient from accidental
injury.
, 4. A 10-year-old child with Juvenile Idiopathic Arthritis (JIA) is experiencing significant
morning stiffness. Which intervention should the nurse recommend to the parents?
A. Apply cold packs to joints immediately upon awakening
B. Perform vigorous weight-bearing exercises before breakfast
C. Maintain complete bed rest until the pain subsides
D. Encourage a warm bath or shower every morning
Answer: D
Rationale: Morning stiffness in JIA is effectively managed by the application of heat to
increase circulation and joint flexibility. A warm bath or shower helps loosen stiff joints
and reduces discomfort, facilitating better movement throughout the day. Promoting
mobility is essential for these children, as prolonged inactivity actually increases stiffness
and joint contractures.
5. An infant with pyloric stenosis is scheduled for a pyloromyotomy. Which acid-base
imbalance is the nurse most likely to observe in this patient?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Respiratory acidosis
D. Metabolic alkalosis
Answer: D
