GALEN COLLEGE OF NURSING – NSG 3600 NURSING PRACTICE – CHILDREN’S HEALTH EXAM
4 – QUESTIONS AND ANSWERS | 2026/2027 LATEST UPDATE
SECTION 1: UNIT 9 — NEUROLOGICAL AND COGNITIVE CONDITIONS
Questions 1–10
ADHD, Down Syndrome, Autism Spectrum Disorder, Child Maltreatment
1. A school-age child has persistent inattention, impulsivity, and hyperactive behavior
across home and school settings. Which neurotransmitters are most closely
associated with ADHD?
A) Dopamine and norepinephrine
B) Serotonin and acetylcholine
C) Gamma-aminobutyric acid and glutamate
D) Histamine and melatonin
Correct Answer: Dopamine and norepinephrine
Rationale: ADHD is associated with altered dopamine and norepinephrine activity in brain
systems involved in attention, impulse control, and executive functioning. These
neurotransmitters are important targets of stimulant therapy. Serotonin, acetylcholine,
GABA, and histamine have other important neurologic roles but are not the principal
neurotransmitters emphasized in ADHD pathophysiology.
2. During medication teaching, the parent of a child prescribed methylphenidate asks
how the dose is adjusted. The most appropriate explanation is that the dose is
primarily titrated according to:
A) The child's age
B) Clinical response and symptom control
C) The child's height
D) A fixed dose determined by school grade
Correct Answer: Clinical response and symptom control
Rationale: Stimulant therapy for ADHD is individualized according to therapeutic response
and adverse effects rather than being determined solely by age, height, or school grade. The
goal is to identify the lowest effective dose that improves functioning. Ongoing monitoring of
appetite, sleep, growth, cardiovascular status, and behavioral response is important.
3. A child with ADHD begins a stimulant medication. Which assessment finding should
the nurse monitor particularly closely during follow-up visits?
,A) Increased appetite
B) Increased sleep duration
C) Decreased appetite and slowed weight gain
D) Increased urinary output
Correct Answer: Decreased appetite and slowed weight gain
Rationale: Appetite suppression is a common adverse effect of stimulant medications used
for ADHD and can contribute to inadequate weight gain. Growth should therefore be
monitored regularly. Increased appetite and urinary output are not characteristic stimulant
effects, while increased sleep is not the expected response to these activating medications.
4. A child with autism spectrum disorder becomes distressed whenever the daily
schedule changes unexpectedly. Which nursing intervention is most appropriate?
A) Remove all routines to encourage flexibility
B) Use punishment when repetitive behaviors occur
C) Encourage frequent unexpected transitions
D) Provide predictable routines and advance warning of changes
Correct Answer: Provide predictable routines and advance warning of changes
Rationale: Children with autism may experience significant distress with changes in routine
because insistence on sameness and difficulty with transitions can be part of the disorder.
Predictability can reduce anxiety and improve cooperation. Visual schedules and advance
preparation for transitions are generally more therapeutic than punishment or deliberately
creating unexpected changes.
5. A developmental assessment is being performed on a toddler suspected of having
autism spectrum disorder. Which behavior most strongly supports the possibility of
ASD?
A) Persistent difficulty with social communication accompanied by repetitive behaviors
B) Occasional separation anxiety
C) Preference for playing independently during one visit
D) Temporary shyness around unfamiliar adults
Correct Answer: Persistent difficulty with social communication accompanied by repetitive
behaviors
Rationale: ASD is characterized by persistent deficits in social communication and interaction
together with restricted or repetitive behaviors or interests. A single episode of shyness or
,independent play is not sufficient for diagnosis. Professional assessment incorporates
developmental history, caregiver observations, and direct observation rather than relying on
one isolated behavior.
6. An infant has hypotonia, characteristic facial features, and developmental delay. The
findings are most consistent with which condition?
A) Turner syndrome
B) Down syndrome
C) Fragile X syndrome
D) Marfan syndrome
Correct Answer: Down syndrome
Rationale: Down syndrome results most commonly from trisomy 21 and is associated with
characteristic facial features, hypotonia, short stature, and developmental differences.
Turner syndrome involves monosomy X and primarily affects females. Fragile X and Marfan
syndrome have different genetic mechanisms and clinical patterns.
7. A nurse suspects child maltreatment after observing injuries that do not match the
caregiver's explanation. What is the nurse's priority responsibility?
A) Wait until another injury occurs
B) Ask the caregiver to investigate the child independently
C) Follow mandated reporting requirements and institutional procedures
D) Confront the suspected perpetrator immediately
Correct Answer: Follow mandated reporting requirements and institutional procedures
Rationale: Nurses are mandated reporters in situations involving reasonable suspicion of
child abuse or neglect according to applicable law and institutional policy. The nurse does
not need to prove abuse before reporting. Delaying action or confronting a suspected
perpetrator can increase risk and interfere with an appropriate protective investigation.
8. A child with ASD is hospitalized for a procedure. Which approach is most likely to
promote cooperation?
A) Use abstract explanations without visual support
B) Change caregivers frequently
C) Avoid explaining the procedure until it begins
D) Use simple language, familiar routines, and visual preparation
, Correct Answer: Use simple language, familiar routines, and visual preparation
Rationale: Children with ASD may benefit from concrete communication, predictable
routines, visual supports, and preparation for unfamiliar experiences. These approaches
reduce uncertainty and sensory stress. Abrupt changes, abstract explanations, and
withholding information until the procedure begins can increase anxiety and behavioral
distress.
9. Parents ask why early developmental assessment is important for a child showing
possible ASD characteristics. The nurse should explain that early identification can:
A) Eliminate every future symptom
B) Support timely intervention and developmental services
C) Guarantee normal developmental outcomes
D) Replace the need for continued assessment
Correct Answer: Support timely intervention and developmental services
Rationale: Early identification of ASD can facilitate access to developmental, behavioral,
communication, educational, and family-support services. It does not guarantee elimination
of symptoms or a specific developmental outcome. Children should continue to receive
individualized assessment because developmental needs and strengths can change over
time.
10. A child with Down syndrome is preparing for a routine health evaluation. Which
nursing principle is especially important?
A) Assume developmental age is identical to chronological age
B) Avoid assessing the child because parents know the child best
C) Provide age-appropriate care while accounting for individual developmental needs
D) Use infant-level communication for every child with Down syndrome
Correct Answer: Provide age-appropriate care while accounting for individual
developmental needs
Rationale: Children with Down syndrome require individualized, developmentally appropriate
care rather than assumptions based solely on diagnosis. Communication, assessment, and
teaching should reflect the child's developmental level while maintaining respect appropriate
to chronological age. Individual strengths, limitations, family priorities, and associated
health conditions should guide nursing care.
SECTION 2: UNIT 9 — ENDOCRINE DISORDERS
Questions 11–18
4 – QUESTIONS AND ANSWERS | 2026/2027 LATEST UPDATE
SECTION 1: UNIT 9 — NEUROLOGICAL AND COGNITIVE CONDITIONS
Questions 1–10
ADHD, Down Syndrome, Autism Spectrum Disorder, Child Maltreatment
1. A school-age child has persistent inattention, impulsivity, and hyperactive behavior
across home and school settings. Which neurotransmitters are most closely
associated with ADHD?
A) Dopamine and norepinephrine
B) Serotonin and acetylcholine
C) Gamma-aminobutyric acid and glutamate
D) Histamine and melatonin
Correct Answer: Dopamine and norepinephrine
Rationale: ADHD is associated with altered dopamine and norepinephrine activity in brain
systems involved in attention, impulse control, and executive functioning. These
neurotransmitters are important targets of stimulant therapy. Serotonin, acetylcholine,
GABA, and histamine have other important neurologic roles but are not the principal
neurotransmitters emphasized in ADHD pathophysiology.
2. During medication teaching, the parent of a child prescribed methylphenidate asks
how the dose is adjusted. The most appropriate explanation is that the dose is
primarily titrated according to:
A) The child's age
B) Clinical response and symptom control
C) The child's height
D) A fixed dose determined by school grade
Correct Answer: Clinical response and symptom control
Rationale: Stimulant therapy for ADHD is individualized according to therapeutic response
and adverse effects rather than being determined solely by age, height, or school grade. The
goal is to identify the lowest effective dose that improves functioning. Ongoing monitoring of
appetite, sleep, growth, cardiovascular status, and behavioral response is important.
3. A child with ADHD begins a stimulant medication. Which assessment finding should
the nurse monitor particularly closely during follow-up visits?
,A) Increased appetite
B) Increased sleep duration
C) Decreased appetite and slowed weight gain
D) Increased urinary output
Correct Answer: Decreased appetite and slowed weight gain
Rationale: Appetite suppression is a common adverse effect of stimulant medications used
for ADHD and can contribute to inadequate weight gain. Growth should therefore be
monitored regularly. Increased appetite and urinary output are not characteristic stimulant
effects, while increased sleep is not the expected response to these activating medications.
4. A child with autism spectrum disorder becomes distressed whenever the daily
schedule changes unexpectedly. Which nursing intervention is most appropriate?
A) Remove all routines to encourage flexibility
B) Use punishment when repetitive behaviors occur
C) Encourage frequent unexpected transitions
D) Provide predictable routines and advance warning of changes
Correct Answer: Provide predictable routines and advance warning of changes
Rationale: Children with autism may experience significant distress with changes in routine
because insistence on sameness and difficulty with transitions can be part of the disorder.
Predictability can reduce anxiety and improve cooperation. Visual schedules and advance
preparation for transitions are generally more therapeutic than punishment or deliberately
creating unexpected changes.
5. A developmental assessment is being performed on a toddler suspected of having
autism spectrum disorder. Which behavior most strongly supports the possibility of
ASD?
A) Persistent difficulty with social communication accompanied by repetitive behaviors
B) Occasional separation anxiety
C) Preference for playing independently during one visit
D) Temporary shyness around unfamiliar adults
Correct Answer: Persistent difficulty with social communication accompanied by repetitive
behaviors
Rationale: ASD is characterized by persistent deficits in social communication and interaction
together with restricted or repetitive behaviors or interests. A single episode of shyness or
,independent play is not sufficient for diagnosis. Professional assessment incorporates
developmental history, caregiver observations, and direct observation rather than relying on
one isolated behavior.
6. An infant has hypotonia, characteristic facial features, and developmental delay. The
findings are most consistent with which condition?
A) Turner syndrome
B) Down syndrome
C) Fragile X syndrome
D) Marfan syndrome
Correct Answer: Down syndrome
Rationale: Down syndrome results most commonly from trisomy 21 and is associated with
characteristic facial features, hypotonia, short stature, and developmental differences.
Turner syndrome involves monosomy X and primarily affects females. Fragile X and Marfan
syndrome have different genetic mechanisms and clinical patterns.
7. A nurse suspects child maltreatment after observing injuries that do not match the
caregiver's explanation. What is the nurse's priority responsibility?
A) Wait until another injury occurs
B) Ask the caregiver to investigate the child independently
C) Follow mandated reporting requirements and institutional procedures
D) Confront the suspected perpetrator immediately
Correct Answer: Follow mandated reporting requirements and institutional procedures
Rationale: Nurses are mandated reporters in situations involving reasonable suspicion of
child abuse or neglect according to applicable law and institutional policy. The nurse does
not need to prove abuse before reporting. Delaying action or confronting a suspected
perpetrator can increase risk and interfere with an appropriate protective investigation.
8. A child with ASD is hospitalized for a procedure. Which approach is most likely to
promote cooperation?
A) Use abstract explanations without visual support
B) Change caregivers frequently
C) Avoid explaining the procedure until it begins
D) Use simple language, familiar routines, and visual preparation
, Correct Answer: Use simple language, familiar routines, and visual preparation
Rationale: Children with ASD may benefit from concrete communication, predictable
routines, visual supports, and preparation for unfamiliar experiences. These approaches
reduce uncertainty and sensory stress. Abrupt changes, abstract explanations, and
withholding information until the procedure begins can increase anxiety and behavioral
distress.
9. Parents ask why early developmental assessment is important for a child showing
possible ASD characteristics. The nurse should explain that early identification can:
A) Eliminate every future symptom
B) Support timely intervention and developmental services
C) Guarantee normal developmental outcomes
D) Replace the need for continued assessment
Correct Answer: Support timely intervention and developmental services
Rationale: Early identification of ASD can facilitate access to developmental, behavioral,
communication, educational, and family-support services. It does not guarantee elimination
of symptoms or a specific developmental outcome. Children should continue to receive
individualized assessment because developmental needs and strengths can change over
time.
10. A child with Down syndrome is preparing for a routine health evaluation. Which
nursing principle is especially important?
A) Assume developmental age is identical to chronological age
B) Avoid assessing the child because parents know the child best
C) Provide age-appropriate care while accounting for individual developmental needs
D) Use infant-level communication for every child with Down syndrome
Correct Answer: Provide age-appropriate care while accounting for individual
developmental needs
Rationale: Children with Down syndrome require individualized, developmentally appropriate
care rather than assumptions based solely on diagnosis. Communication, assessment, and
teaching should reflect the child's developmental level while maintaining respect appropriate
to chronological age. Individual strengths, limitations, family priorities, and associated
health conditions should guide nursing care.
SECTION 2: UNIT 9 — ENDOCRINE DISORDERS
Questions 11–18
