NUR 254 EXAM 3 - COMPREHENSIVE
EXAMINATION
GALEN COLLEGE OF NURSING - LATEST 2025/2026
1. The nurse is teaching the mother of a child who has celiac disease about appropriate food choices.
Which foods from the box below identified by the mother indicate a need for further teaching?
Chicken breast
Oatmeal
Instant soup
Bananas
Apple slices
Spaghetti
Sugar-free cherry pie
a. 2, 3, 6, 7
b. 2, 4, 6, 7
c. 3, 4, 6, 7
,d. 1, 2, 3, 7
ANSWER: a. 2, 3, 6, 7
Rationale for Option A (Correct): Oatmeal, instant soup, spaghetti, and sugar-free cherry pie contain
gluten or may be cross-contaminated with gluten. Celiac disease requires a strict gluten-free diet.
Oatmeal is often contaminated with wheat during processing, instant soups typically contain wheat-
based thickeners, spaghetti is wheat-based pasta, and sugar-free pie may contain gluten in the crust or
thickeners.
Rationale for Option B (Incorrect): This option incorrectly identifies bananas as a problem food. Bananas
are naturally gluten-free and safe for children with celiac disease.
Rationale for Option C (Incorrect): This option incorrectly identifies bananas as unsafe while omitting
oatmeal, which is a concern due to cross-contamination.
Rationale for Option D (Incorrect): This option incorrectly identifies chicken breast as unsafe. Plain
chicken breast without breading or seasonings is gluten-free and safe.
2. The nurse is caring for a child with probable intussusception. Which of the following is the most
appropriate nursing action when the child has a normal, brown stool?
a. Notify the primary health care provider (PHCP)
b. Auscultate for bowel sounds
c. Take vital signs, including blood pressure (BP)
d. Measure the child's abdominal girth
ANSWER: a. Notify the primary health care provider (PHCP)
Rationale for Option A (Correct): In intussusception, the passage of a normal brown stool is a significant
finding that may indicate spontaneous reduction of the intussusception. The PHCP must be notified
immediately as this changes the treatment plan and may eliminate the need for intervention.
,Rationale for Option B (Incorrect): Auscultating for bowel sounds is a routine assessment but is not the
priority action when a significant clinical change such as normal stool passage occurs. This can be done
after notifying the provider.
Rationale for Option C (Incorrect): Taking vital signs is important but is not the priority when a
potentially positive change in condition occurs. The provider needs to know about this critical finding
first.
Rationale for Option D (Incorrect): Measuring abdominal girth is part of ongoing assessment but does
not take priority over notifying the provider about the passage of normal stool, which could indicate
resolution of the condition.
3. The nurse is assessing a child who is suspected of having celiac disease. Which of the following
findings should the nurse expect the parents to report?
a. Black and tarry stools
b. Excessive hunger
c. Chronic constipation
d. Steatorrhea
ANSWER: d. Steatorrhea
Rationale for Option A (Incorrect): Black and tarry stools (melena) indicate upper gastrointestinal
bleeding, which is not characteristic of celiac disease. This finding would suggest bleeding ulcers or other
hemorrhagic conditions.
Rationale for Option B (Incorrect): Excessive hunger (polyphagia) is not a classic symptom of celiac
disease. While malnutrition can occur due to malabsorption, excessive hunger is more characteristic of
conditions like diabetes mellitus or hyperthyroidism.
, Rationale for Option C (Incorrect): Chronic constipation is not a hallmark symptom of celiac disease.
Celiac disease typically presents with diarrhea, steatorrhea, weight loss, and failure to thrive due to
malabsorption of nutrients.
Rationale for Option D (Correct): Steatorrhea (fatty, foul-smelling, floating stools) is a classic finding in
celiac disease. It results from the malabsorption of fats due to damage to the intestinal villi from gluten
exposure.
4. The nurse has attended a continuing education conference on enuresis. Which of the following
statements by the nurse indicates a correct understanding of the conference?
a. "One intervention for nocturnal enuresis is using the restroom before going to bed."
b. "Children who have phenylketonuria (PKU) typically demonstrate enuresis by age 3 years."
c. "Children who suffer from enuresis have inappropriate defecation at least twice a week for at least 3
months."
d. "The medication most frequently prescribed to treat enuresis is haloperidol."
ANSWER: a. "One intervention for nocturnal enuresis is using the restroom before going to bed."
Rationale for Option A (Correct): Using the restroom before bedtime is a standard behavioral
intervention for nocturnal enuresis. This promotes bladder emptying before sleep and is part of a
comprehensive management plan.
Rationale for Option B (Incorrect): PKU is not associated with enuresis. PKU is an inborn error of
metabolism affecting phenylalanine breakdown. Enuresis is not a typical manifestation of PKU.
Rationale for Option C (Incorrect): This describes encopresis (inappropriate defecation), not enuresis
(inappropriate urination). The criteria for encopresis include inappropriate defecation at least once a
month for 3 months, not enuresis.
Rationale for Option D (Incorrect): Haloperidol is an antipsychotic medication, not used for enuresis.
Desmopressin acetate (DDAVP) and imipramine are medications commonly prescribed for enuresis.
EXAMINATION
GALEN COLLEGE OF NURSING - LATEST 2025/2026
1. The nurse is teaching the mother of a child who has celiac disease about appropriate food choices.
Which foods from the box below identified by the mother indicate a need for further teaching?
Chicken breast
Oatmeal
Instant soup
Bananas
Apple slices
Spaghetti
Sugar-free cherry pie
a. 2, 3, 6, 7
b. 2, 4, 6, 7
c. 3, 4, 6, 7
,d. 1, 2, 3, 7
ANSWER: a. 2, 3, 6, 7
Rationale for Option A (Correct): Oatmeal, instant soup, spaghetti, and sugar-free cherry pie contain
gluten or may be cross-contaminated with gluten. Celiac disease requires a strict gluten-free diet.
Oatmeal is often contaminated with wheat during processing, instant soups typically contain wheat-
based thickeners, spaghetti is wheat-based pasta, and sugar-free pie may contain gluten in the crust or
thickeners.
Rationale for Option B (Incorrect): This option incorrectly identifies bananas as a problem food. Bananas
are naturally gluten-free and safe for children with celiac disease.
Rationale for Option C (Incorrect): This option incorrectly identifies bananas as unsafe while omitting
oatmeal, which is a concern due to cross-contamination.
Rationale for Option D (Incorrect): This option incorrectly identifies chicken breast as unsafe. Plain
chicken breast without breading or seasonings is gluten-free and safe.
2. The nurse is caring for a child with probable intussusception. Which of the following is the most
appropriate nursing action when the child has a normal, brown stool?
a. Notify the primary health care provider (PHCP)
b. Auscultate for bowel sounds
c. Take vital signs, including blood pressure (BP)
d. Measure the child's abdominal girth
ANSWER: a. Notify the primary health care provider (PHCP)
Rationale for Option A (Correct): In intussusception, the passage of a normal brown stool is a significant
finding that may indicate spontaneous reduction of the intussusception. The PHCP must be notified
immediately as this changes the treatment plan and may eliminate the need for intervention.
,Rationale for Option B (Incorrect): Auscultating for bowel sounds is a routine assessment but is not the
priority action when a significant clinical change such as normal stool passage occurs. This can be done
after notifying the provider.
Rationale for Option C (Incorrect): Taking vital signs is important but is not the priority when a
potentially positive change in condition occurs. The provider needs to know about this critical finding
first.
Rationale for Option D (Incorrect): Measuring abdominal girth is part of ongoing assessment but does
not take priority over notifying the provider about the passage of normal stool, which could indicate
resolution of the condition.
3. The nurse is assessing a child who is suspected of having celiac disease. Which of the following
findings should the nurse expect the parents to report?
a. Black and tarry stools
b. Excessive hunger
c. Chronic constipation
d. Steatorrhea
ANSWER: d. Steatorrhea
Rationale for Option A (Incorrect): Black and tarry stools (melena) indicate upper gastrointestinal
bleeding, which is not characteristic of celiac disease. This finding would suggest bleeding ulcers or other
hemorrhagic conditions.
Rationale for Option B (Incorrect): Excessive hunger (polyphagia) is not a classic symptom of celiac
disease. While malnutrition can occur due to malabsorption, excessive hunger is more characteristic of
conditions like diabetes mellitus or hyperthyroidism.
, Rationale for Option C (Incorrect): Chronic constipation is not a hallmark symptom of celiac disease.
Celiac disease typically presents with diarrhea, steatorrhea, weight loss, and failure to thrive due to
malabsorption of nutrients.
Rationale for Option D (Correct): Steatorrhea (fatty, foul-smelling, floating stools) is a classic finding in
celiac disease. It results from the malabsorption of fats due to damage to the intestinal villi from gluten
exposure.
4. The nurse has attended a continuing education conference on enuresis. Which of the following
statements by the nurse indicates a correct understanding of the conference?
a. "One intervention for nocturnal enuresis is using the restroom before going to bed."
b. "Children who have phenylketonuria (PKU) typically demonstrate enuresis by age 3 years."
c. "Children who suffer from enuresis have inappropriate defecation at least twice a week for at least 3
months."
d. "The medication most frequently prescribed to treat enuresis is haloperidol."
ANSWER: a. "One intervention for nocturnal enuresis is using the restroom before going to bed."
Rationale for Option A (Correct): Using the restroom before bedtime is a standard behavioral
intervention for nocturnal enuresis. This promotes bladder emptying before sleep and is part of a
comprehensive management plan.
Rationale for Option B (Incorrect): PKU is not associated with enuresis. PKU is an inborn error of
metabolism affecting phenylalanine breakdown. Enuresis is not a typical manifestation of PKU.
Rationale for Option C (Incorrect): This describes encopresis (inappropriate defecation), not enuresis
(inappropriate urination). The criteria for encopresis include inappropriate defecation at least once a
month for 3 months, not enuresis.
Rationale for Option D (Incorrect): Haloperidol is an antipsychotic medication, not used for enuresis.
Desmopressin acetate (DDAVP) and imipramine are medications commonly prescribed for enuresis.
