,NSG 434 – Comprehensive Final Exam
Questions and Answers with Rationale
2026/2027 Update
Question 1: Oncologic Emergencies & Pre-Op Care
A 3-year-old child is admitted with a suspected Wilms tumor
(nephroblastoma). Which of the following is a critical nursing
intervention during the preoperative phase?
A. Routinely palpate the abdomen every shift to monitor
tumor growth.
B. Ensure the abdomen is clearly marked: "Do Not Palpate."
C. Encourage active floor play to minimize hospital anxiety.
D. Administer prescribed aspirin for low-grade fever.
Correct Answer: B. Ensure the abdomen is clearly marked:
"Do Not Palpate."
Expert Rationale: A Wilms tumor is a malignant renal and
intra-abdominal tumor. Palpation of the abdomen is strictly
contraindicated because manipulation can rupture the delicate
capsule, releasing cancer cells into adjacent abdominal
structures and metastasizing the disease.
Question 2: Respiratory Emergencies
A 4-year-old child presents to the emergency department with
sudden onset of drooling, severe agitation, a "froglike" croaking
,sound on inspiration, and high fever. What is the most
appropriate initial nursing action?
A. Examine the throat thoroughly with a tongue depressor to
check tonsillar size.
B. Position the child flat on their back and administer oral
cough syrup.
C. Notify the physician immediately and prepare for
emergency intubation or tracheostomy.
D. Draw immediate arterial blood gases (ABGs) to check
oxygen saturation.
Correct Answer: C. Notify the physician immediately and
prepare for emergency intubation or tracheostomy.
Expert Rationale: These are classic signs of acute epiglottitis
(commonly caused by Haemophilus influenzae), which is a life-
threatening airway obstruction. Never inspect the throat with a
tongue depressor or attempt visual visualization because it
can trigger total, catastrophic laryngospasm and complete
airway collapse. Keep emergency airway equipment ready at the
bedside.
Question 3: Gastrointestinal Conditions
An infant is brought to the clinic with episodes of crying,
drawing legs up to the abdomen, vomiting, and passing stools
that resemble "currant jelly" mixed with blood and mucus. The
nurse suspects which condition?
A. Pyloric stenosis
, B. Intussusception
C. Hirschsprung disease
D. Appendicitis
Correct Answer: B. Intussusception
Expert Rationale: Intussusception occurs when a segment of
the bowel telescopes into another, causing mechanical
obstruction, ischemia, and mucus/blood leakage known
classically as currant jelly-like stools. It is a
surgical/radiological emergency requiring air or hydrostatic
enema reduction.
Question 4: Hematologic Disorders
A school-age male child with severe hemophilia A sustains a
knee injury during recess, resulting in acute hemarthrosis
(bleeding into the joint space). Which immediate management
steps should the nurse anticipate?
A. Massage the joint vigorously and apply active range-of-
motion exercises.
B. Apply heat compresses and encourage ambulation.
C. Administer factor replacement, rest, ice, compression, and
elevation (RICE).
D. Prepare the child for emergency joint aspiration.
Correct Answer: C. Administer factor replacement, rest, ice,
compression, and elevation (RICE).
Questions and Answers with Rationale
2026/2027 Update
Question 1: Oncologic Emergencies & Pre-Op Care
A 3-year-old child is admitted with a suspected Wilms tumor
(nephroblastoma). Which of the following is a critical nursing
intervention during the preoperative phase?
A. Routinely palpate the abdomen every shift to monitor
tumor growth.
B. Ensure the abdomen is clearly marked: "Do Not Palpate."
C. Encourage active floor play to minimize hospital anxiety.
D. Administer prescribed aspirin for low-grade fever.
Correct Answer: B. Ensure the abdomen is clearly marked:
"Do Not Palpate."
Expert Rationale: A Wilms tumor is a malignant renal and
intra-abdominal tumor. Palpation of the abdomen is strictly
contraindicated because manipulation can rupture the delicate
capsule, releasing cancer cells into adjacent abdominal
structures and metastasizing the disease.
Question 2: Respiratory Emergencies
A 4-year-old child presents to the emergency department with
sudden onset of drooling, severe agitation, a "froglike" croaking
,sound on inspiration, and high fever. What is the most
appropriate initial nursing action?
A. Examine the throat thoroughly with a tongue depressor to
check tonsillar size.
B. Position the child flat on their back and administer oral
cough syrup.
C. Notify the physician immediately and prepare for
emergency intubation or tracheostomy.
D. Draw immediate arterial blood gases (ABGs) to check
oxygen saturation.
Correct Answer: C. Notify the physician immediately and
prepare for emergency intubation or tracheostomy.
Expert Rationale: These are classic signs of acute epiglottitis
(commonly caused by Haemophilus influenzae), which is a life-
threatening airway obstruction. Never inspect the throat with a
tongue depressor or attempt visual visualization because it
can trigger total, catastrophic laryngospasm and complete
airway collapse. Keep emergency airway equipment ready at the
bedside.
Question 3: Gastrointestinal Conditions
An infant is brought to the clinic with episodes of crying,
drawing legs up to the abdomen, vomiting, and passing stools
that resemble "currant jelly" mixed with blood and mucus. The
nurse suspects which condition?
A. Pyloric stenosis
, B. Intussusception
C. Hirschsprung disease
D. Appendicitis
Correct Answer: B. Intussusception
Expert Rationale: Intussusception occurs when a segment of
the bowel telescopes into another, causing mechanical
obstruction, ischemia, and mucus/blood leakage known
classically as currant jelly-like stools. It is a
surgical/radiological emergency requiring air or hydrostatic
enema reduction.
Question 4: Hematologic Disorders
A school-age male child with severe hemophilia A sustains a
knee injury during recess, resulting in acute hemarthrosis
(bleeding into the joint space). Which immediate management
steps should the nurse anticipate?
A. Massage the joint vigorously and apply active range-of-
motion exercises.
B. Apply heat compresses and encourage ambulation.
C. Administer factor replacement, rest, ice, compression, and
elevation (RICE).
D. Prepare the child for emergency joint aspiration.
Correct Answer: C. Administer factor replacement, rest, ice,
compression, and elevation (RICE).
