NUR 254 EXAM 4 | NURSING 254
MATERNAL EXAM 4 EXAM
QUESTIONS & ANSWERS,
EXPLAINED SOLUTIONS | 2025-2026
The nurse is caring for a child who has leukemia with a white blood cell (WBC) count of
< 1000 mm. Which of the following should the nurse include in the child's plan of care? -
ANSWERSAdminister prescribed influenza vaccination
The nurse is providing a teaching session to the health care staff regarding
osteosarcoma. Which of the following statements by an attendee indicates a need for
additional teaching? - ANSWERS"In the early stage, the symptoms of this disease are
usually attributed to normal growing pains.
The nurse is caring for a child who is suspected of having a Wilm's tumor. Which of the
following actions by the nurse indicates the need for additional training? -
ANSWERSPalpating the child's abdomen
The nurse is caring for a 5-year-old child who has sickle cell disease (SCD). An
assessment of the child includes the following: respirations 10 and unarousable. The
child is currently on intravenous (IV) fluids and continuous IV morphine sulfate Based on
the assessment information, which of the following actions should the nurse take first? -
ANSWERSAdminister naloxone to reverse the effect of the morphine.
The nurse is admitting a child who has a vaso-occlusive sickle cell crisis. Which of the
following interventions should the nurse anticipate to be prescribed for the child? -
ANSWERSHydration and pain management
The nurse working in the emergency department (ED) is caring for a child who has
hemophilia and developed a swollen knee after falling off a bicycle. The nurse is
teaching the child's parents about care when similar incidents occur at home in the
future. Which of the following actions should the nurse teach the parents? -
ANSWERSApply an ice pack and compression dressings to the knee.
The newly hired nurse is talking with the nurse preceptor about the prevention of
irondeficiency anemia in infants. Which of the following statements by the newly hired
nurse is correct regarding prevention of this condition? - ANSWERS"Iron-fortified
commercial formula should be given for the first 6 months of life
The nurse is assessing a child who has severe iron deficiency anemia. Which of the
following assessment finds should the nurse expect to observe? - ANSWERSPallor
, The nurse is caring for 4-year-old child who is 36 hours postoperative following a
removal of a Wilm'stumor. Which of the following requires immediate follow up by the
nurse? - ANSWERSIncision site is pink at the edges.
The nurse is providing discharge instructions to the parents of a child who had surgical
resection of a neuroblastoma 4 days ago. Which of the following statements by the
parents indicates teaching has been effective? - ANSWERSWe will provide pain relief
using pain medication and rest."
The nurse is caring for a child who has increased intracranial pressure (ICP) and is in
stable condition. Which of the following interventionsshould the nurse implement to
decrease ICP in the child? - ANSWERSLimit number of visitors inside the child's room.
The nurse is caring for a child who has Reye's syndrome. Which of the following should
the nurse include in the child's plan of care - ANSWERSProvide the child a quiet
atmosphere with dimmed lighting
The nurse is caring for a child who is suspected of having bacterial meningitis. The
results of the lumbar puncture are still pending. Which of the following actions by the
nurse is the priority? - ANSWERSAssessing neurological status every 2-4 hours.
The nurse is screening infants for early warning signs of cerebral palsy. Which of the
following should the nurse recognize as 1 of the early warning signs of cerebral palsy? -
ANSWERSPoor head control
The nurse is assessing a 6-year-old for manifestations of autism spectrum disorder.
Which of the following manifestations should the nurse expect to observe in this child? -
ANSWERSMonotone speech
. The nurse is developing a plan of care for a child diagnosed with attention-deficit
hyperactivity disorder (ADHD). Which of the following information should the nurse
include in the plan of care? - ANSWERSPsychostimulant medications and behavior
modification.
The nurse preceptor is observing a newly hired nurse care for a child who has Down
syndrome. Which of the following manifestations, if documented by the newly hired
nurse, requires follow up by the nurse preceptor? - ANSWERSProtruding tongue
The nurse is caring for a child who had a ventricular shunt placement 24 hours ago. The
child is sitting up in bed crying and has vomited a small amount on the bed linens.
Which of the following actions should the nurse take first? - ANSWERSComplete a
neurological assessment.
The nurse working in the emergency department (ED) is caring for a 2-month-old child
who presents with intraocular bleeding, bradycardia, and bulging fontanels, but no
MATERNAL EXAM 4 EXAM
QUESTIONS & ANSWERS,
EXPLAINED SOLUTIONS | 2025-2026
The nurse is caring for a child who has leukemia with a white blood cell (WBC) count of
< 1000 mm. Which of the following should the nurse include in the child's plan of care? -
ANSWERSAdminister prescribed influenza vaccination
The nurse is providing a teaching session to the health care staff regarding
osteosarcoma. Which of the following statements by an attendee indicates a need for
additional teaching? - ANSWERS"In the early stage, the symptoms of this disease are
usually attributed to normal growing pains.
The nurse is caring for a child who is suspected of having a Wilm's tumor. Which of the
following actions by the nurse indicates the need for additional training? -
ANSWERSPalpating the child's abdomen
The nurse is caring for a 5-year-old child who has sickle cell disease (SCD). An
assessment of the child includes the following: respirations 10 and unarousable. The
child is currently on intravenous (IV) fluids and continuous IV morphine sulfate Based on
the assessment information, which of the following actions should the nurse take first? -
ANSWERSAdminister naloxone to reverse the effect of the morphine.
The nurse is admitting a child who has a vaso-occlusive sickle cell crisis. Which of the
following interventions should the nurse anticipate to be prescribed for the child? -
ANSWERSHydration and pain management
The nurse working in the emergency department (ED) is caring for a child who has
hemophilia and developed a swollen knee after falling off a bicycle. The nurse is
teaching the child's parents about care when similar incidents occur at home in the
future. Which of the following actions should the nurse teach the parents? -
ANSWERSApply an ice pack and compression dressings to the knee.
The newly hired nurse is talking with the nurse preceptor about the prevention of
irondeficiency anemia in infants. Which of the following statements by the newly hired
nurse is correct regarding prevention of this condition? - ANSWERS"Iron-fortified
commercial formula should be given for the first 6 months of life
The nurse is assessing a child who has severe iron deficiency anemia. Which of the
following assessment finds should the nurse expect to observe? - ANSWERSPallor
, The nurse is caring for 4-year-old child who is 36 hours postoperative following a
removal of a Wilm'stumor. Which of the following requires immediate follow up by the
nurse? - ANSWERSIncision site is pink at the edges.
The nurse is providing discharge instructions to the parents of a child who had surgical
resection of a neuroblastoma 4 days ago. Which of the following statements by the
parents indicates teaching has been effective? - ANSWERSWe will provide pain relief
using pain medication and rest."
The nurse is caring for a child who has increased intracranial pressure (ICP) and is in
stable condition. Which of the following interventionsshould the nurse implement to
decrease ICP in the child? - ANSWERSLimit number of visitors inside the child's room.
The nurse is caring for a child who has Reye's syndrome. Which of the following should
the nurse include in the child's plan of care - ANSWERSProvide the child a quiet
atmosphere with dimmed lighting
The nurse is caring for a child who is suspected of having bacterial meningitis. The
results of the lumbar puncture are still pending. Which of the following actions by the
nurse is the priority? - ANSWERSAssessing neurological status every 2-4 hours.
The nurse is screening infants for early warning signs of cerebral palsy. Which of the
following should the nurse recognize as 1 of the early warning signs of cerebral palsy? -
ANSWERSPoor head control
The nurse is assessing a 6-year-old for manifestations of autism spectrum disorder.
Which of the following manifestations should the nurse expect to observe in this child? -
ANSWERSMonotone speech
. The nurse is developing a plan of care for a child diagnosed with attention-deficit
hyperactivity disorder (ADHD). Which of the following information should the nurse
include in the plan of care? - ANSWERSPsychostimulant medications and behavior
modification.
The nurse preceptor is observing a newly hired nurse care for a child who has Down
syndrome. Which of the following manifestations, if documented by the newly hired
nurse, requires follow up by the nurse preceptor? - ANSWERSProtruding tongue
The nurse is caring for a child who had a ventricular shunt placement 24 hours ago. The
child is sitting up in bed crying and has vomited a small amount on the bed linens.
Which of the following actions should the nurse take first? - ANSWERSComplete a
neurological assessment.
The nurse working in the emergency department (ED) is caring for a 2-month-old child
who presents with intraocular bleeding, bradycardia, and bulging fontanels, but no
