NR 328 Exam 4: Pediatric Nursing - Chamberlain
University Updated and Latest Questions and Correct
Answers with Rationale
1. A 6-year-old child is admitted to the pediatric unit with a diagnosis of a vaso-occlusive sickle cell crisis.
Which nursing intervention should the nurse prioritize in the plan of care?
A. Initiating aggressive intravenous hydration to reduce blood viscosity.
B. Administering prophylactic antibiotics to prevent secondary infections.
C. Applying cold compresses to the affected joints to reduce swelling.
D. Restricting oral fluid intake to prevent pulmonary edema.
Correct Answer: A
Rationale: In a vaso-occlusive crisis, sickled red blood cells obstruct blood flow, leading to tissue
ischemia and severe pain. Aggressive hydration is the priority to dilute the blood and promote the flow of
cells through the microvasculature. Cold compresses must be avoided because they cause
vasoconstriction, which further impairs circulation. The nurse must also monitor for signs of fluid
overload while maintaining high infusion rates. Providing adequate pain management and oxygenation
are also essential components of holistic care for these patients.
2. A nurse is assessing a 4-year-old child suspected of having a Wilms tumor. Which action by the nurse is
most critical to ensure patient safety?
A. Auscultating bowel sounds in all four quadrants every 4 hours.
B. Measuring the child’s abdominal circumference at the umbilicus.
C. Placing a ‘Do Not Palpate Abdomen’ sign over the child’s bed.
D. Assisting the child into a prone position for the physical exam.
,Correct Answer: C
Rationale: Wilms tumor, or nephroblastoma, is a common intra-abdominal tumor in children that is
often encapsulated. Palpation of the abdomen can cause the tumor capsule to rupture, leading to the
seeding of cancer cells throughout the peritoneal cavity. Placing a warning sign ensures that all
healthcare providers avoid unnecessary manipulation of the area. The nurse should also monitor blood
pressure closely as these tumors can cause hypertension through renin release. Clinical judgment
requires the nurse to prioritize the integrity of the tumor mass above traditional physical assessment
techniques.
3. A 3-year-old child is brought to the emergency department with drooling, a high fever, and a ‘tripod’
sitting position. What is the nurse’s immediate priority action?
A. Prepare for emergency airway management and notify the provider.
B. Examine the throat using a tongue blade to visualize the epiglottis.
C. Obtain a throat culture to identify the causative organism.
D. Place the child in a supine position to facilitate easier breathing.
Correct Answer: A
Rationale: The symptoms described are classic indicators of epiglottitis, a life-threatening pediatric
emergency that can cause rapid airway obstruction. Any attempt to visualize the throat or use a tongue
blade can trigger a laryngospasm and complete airway closure. The nurse must keep the child calm and
in their preferred position until the airway is secured by expert personnel. Oxygen should be provided
via a non-invasive method that does not increase the child’s distress. Preparing for intubation or
tracheostomy is the highest priority for ensuring the child’s survival during this acute phase.
, 4. A child with hemophilia A has experienced a knee injury during soccer practice. Which initial treatment
should the nurse implement?
A. Perform active range-of-motion exercises to prevent joint stiffness.
B. Administer aspirin for pain relief and to reduce inflammation.
C. Elevate the limb and apply ice to the affected joint.
D. Apply heat packs to the knee for 20 minutes to improve circulation.
Correct Answer: C
Rationale: The RICE (Rest, Ice, Compression, Elevation) method is the standard initial treatment for
acute bleeding episodes in hemophiliacs. Ice promotes vasoconstriction, which helps slow the bleeding
and reduces pain in the affected joint. Aspirin is strictly contraindicated in hemophilia because it inhibits
platelet function and increases the risk of prolonged bleeding. Active range-of-motion exercises should be
delayed until the bleeding is controlled and the acute phase has passed. The nurse must also prepare to
administer the specific clotting factor replacement as ordered to stop the internal hemorrhage.
5. A 10-year-old child is receiving chemotherapy for Acute Lymphocytic Leukemia (ALL). The child’s absolute
neutrophil count (ANC) is 400/mm3. Which intervention is most appropriate?
A. Place the child in a room with a roommate who has a non-infectious condition.
B. Allow the child’s siblings to bring fresh flowers and fruit from home.
C. Implement strict handwashing and neutropenic precautions.
D. Administer the scheduled live-virus vaccines to boost immunity.
Correct Answer: C
Rationale: An ANC below 500/mm3 indicates severe neutropenia, placing the child at an extremely high
risk for life-threatening infections. Neutropenic precautions include strict hand hygiene, a private room,
University Updated and Latest Questions and Correct
Answers with Rationale
1. A 6-year-old child is admitted to the pediatric unit with a diagnosis of a vaso-occlusive sickle cell crisis.
Which nursing intervention should the nurse prioritize in the plan of care?
A. Initiating aggressive intravenous hydration to reduce blood viscosity.
B. Administering prophylactic antibiotics to prevent secondary infections.
C. Applying cold compresses to the affected joints to reduce swelling.
D. Restricting oral fluid intake to prevent pulmonary edema.
Correct Answer: A
Rationale: In a vaso-occlusive crisis, sickled red blood cells obstruct blood flow, leading to tissue
ischemia and severe pain. Aggressive hydration is the priority to dilute the blood and promote the flow of
cells through the microvasculature. Cold compresses must be avoided because they cause
vasoconstriction, which further impairs circulation. The nurse must also monitor for signs of fluid
overload while maintaining high infusion rates. Providing adequate pain management and oxygenation
are also essential components of holistic care for these patients.
2. A nurse is assessing a 4-year-old child suspected of having a Wilms tumor. Which action by the nurse is
most critical to ensure patient safety?
A. Auscultating bowel sounds in all four quadrants every 4 hours.
B. Measuring the child’s abdominal circumference at the umbilicus.
C. Placing a ‘Do Not Palpate Abdomen’ sign over the child’s bed.
D. Assisting the child into a prone position for the physical exam.
,Correct Answer: C
Rationale: Wilms tumor, or nephroblastoma, is a common intra-abdominal tumor in children that is
often encapsulated. Palpation of the abdomen can cause the tumor capsule to rupture, leading to the
seeding of cancer cells throughout the peritoneal cavity. Placing a warning sign ensures that all
healthcare providers avoid unnecessary manipulation of the area. The nurse should also monitor blood
pressure closely as these tumors can cause hypertension through renin release. Clinical judgment
requires the nurse to prioritize the integrity of the tumor mass above traditional physical assessment
techniques.
3. A 3-year-old child is brought to the emergency department with drooling, a high fever, and a ‘tripod’
sitting position. What is the nurse’s immediate priority action?
A. Prepare for emergency airway management and notify the provider.
B. Examine the throat using a tongue blade to visualize the epiglottis.
C. Obtain a throat culture to identify the causative organism.
D. Place the child in a supine position to facilitate easier breathing.
Correct Answer: A
Rationale: The symptoms described are classic indicators of epiglottitis, a life-threatening pediatric
emergency that can cause rapid airway obstruction. Any attempt to visualize the throat or use a tongue
blade can trigger a laryngospasm and complete airway closure. The nurse must keep the child calm and
in their preferred position until the airway is secured by expert personnel. Oxygen should be provided
via a non-invasive method that does not increase the child’s distress. Preparing for intubation or
tracheostomy is the highest priority for ensuring the child’s survival during this acute phase.
, 4. A child with hemophilia A has experienced a knee injury during soccer practice. Which initial treatment
should the nurse implement?
A. Perform active range-of-motion exercises to prevent joint stiffness.
B. Administer aspirin for pain relief and to reduce inflammation.
C. Elevate the limb and apply ice to the affected joint.
D. Apply heat packs to the knee for 20 minutes to improve circulation.
Correct Answer: C
Rationale: The RICE (Rest, Ice, Compression, Elevation) method is the standard initial treatment for
acute bleeding episodes in hemophiliacs. Ice promotes vasoconstriction, which helps slow the bleeding
and reduces pain in the affected joint. Aspirin is strictly contraindicated in hemophilia because it inhibits
platelet function and increases the risk of prolonged bleeding. Active range-of-motion exercises should be
delayed until the bleeding is controlled and the acute phase has passed. The nurse must also prepare to
administer the specific clotting factor replacement as ordered to stop the internal hemorrhage.
5. A 10-year-old child is receiving chemotherapy for Acute Lymphocytic Leukemia (ALL). The child’s absolute
neutrophil count (ANC) is 400/mm3. Which intervention is most appropriate?
A. Place the child in a room with a roommate who has a non-infectious condition.
B. Allow the child’s siblings to bring fresh flowers and fruit from home.
C. Implement strict handwashing and neutropenic precautions.
D. Administer the scheduled live-virus vaccines to boost immunity.
Correct Answer: C
Rationale: An ANC below 500/mm3 indicates severe neutropenia, placing the child at an extremely high
risk for life-threatening infections. Neutropenic precautions include strict hand hygiene, a private room,
