NUR 254 Exam 4: Pediatrics - Galen College of Nursing
Updated and Latest Questions and Correct Answers with
Rationale
1. A nurse is caring for a school-age child experiencing a vaso-occlusive crisis from Sickle Cell Anemia. Which
intervention is the nursing priority?
A. Administering oxygen at 2L/min via nasal cannula
B. Encouraging increased fluid intake and administering IV fluids
C. Applying cold compresses to the painful joints
D. Administering meperidine (Demerol) for pain control
Correct Answer: B
Rationale: Sickle cell crisis is characterized by the clumping of sickled cells which leads to tissue
ischemia and pain. Hydration is the priority intervention because it reduces blood viscosity and prevents
further sickling of the hemoglobin. Oral and intravenous fluids help maintain circulation to the affected
tissues during an acute episode. Cold compresses should be avoided because they cause vasoconstriction
which further impairs blood flow. Pain management is vital, but meperidine is generally avoided in
pediatrics due to the risk of seizures.
2. A child is admitted with a suspected diagnosis of Wilms tumor. Which action should the nurse strictly
avoid during the physical assessment?
A. Measuring the child’s blood pressure
B. Assessing the child’s femoral pulses
C. Auscultating the child’s breath sounds
D. Palpating the child’s abdomen
,Correct Answer: D
Rationale: Wilms tumor, or nephroblastoma, is a firm and encapsulated mass located in the kidney area.
Palpating the abdomen can cause the protective capsule to rupture and spread cancerous cells
throughout the peritoneum. A sign should be placed at the head of the bed to alert all staff to avoid
abdominal palpation. Monitoring blood pressure is actually required as the tumor can cause
hypertension due to increased renin. Pre-operative care focuses on safety and preparing the family for
the surgical removal of the kidney.
3. The nurse is providing discharge instructions to the parents of a child with Hemophilia A. Which activity
should the nurse recommend as safest for this child?
A. Playing on a local soccer team
B. Joining a youth wrestling club
C. Participating in swimming lessons
D. Attending a skateboarding camp
Correct Answer: C
Rationale: Children with hemophilia are at significant risk for internal bleeding and joint damage from
physical trauma. Swimming is a non-contact sport that strengthens muscles without putting excessive
stress or impact on the joints. High-contact sports like wrestling or soccer increase the risk of
hemorrhage and should be discouraged. Parents should be taught to recognize early signs of
hemarthrosis such as joint stiffness or tingling. Safety equipment like helmets and padding should be
worn during any allowed physical activity to prevent injury.
4. A toddler is hospitalized for chemotherapy to treat leukemia. Which laboratory finding would require the
nurse to implement neutropenic precautions?
A. A White Blood Cell (WBC) count of 6,000/mm3
, B. A Hemoglobin level of 10.2 g/dL
C. A Platelet count of 150,000/mm3
D. An Absolute Neutrophil Count (ANC) of 450/mm3
Correct Answer: D
Rationale: Neutropenia occurs when the absolute neutrophil count drops below 500/mm3, significantly
increasing the risk of life-threatening infection. In this state, the child’s immune system is unable to
mount a normal inflammatory response to pathogens. Precautions include strict handwashing,
prohibiting fresh flowers or fruit in the room, and avoiding sick visitors. The nurse should also monitor
the child’s temperature frequently for any signs of fever which is a medical emergency. While low
hemoglobin and platelets are common in leukemia, the low ANC is the direct trigger for these specific
isolation protocols.
5. The nurse is educating the parents of a child with Cystic Fibrosis (CF) about the administration of
pancreatic enzymes. Which statement indicates the parents understand the teaching?
A. I will give the enzymes once a day in the morning.
B. I will mix the enzyme beads with the child’s hot oatmeal.
C. I will give the enzymes with every meal and snack.
D. I will make sure the child chews the enzyme capsules thoroughly.
B. I will give the enzymes with every meal and snack.
Correct Answer: C
Rationale: Children with Cystic Fibrosis have a deficiency of pancreatic enzymes which prevents the
proper digestion of fats and proteins. Enzymes must be taken with every meal and snack to ensure
nutrient absorption and prevent steatorrhea. If the child cannot swallow the capsules, the beads can be
Updated and Latest Questions and Correct Answers with
Rationale
1. A nurse is caring for a school-age child experiencing a vaso-occlusive crisis from Sickle Cell Anemia. Which
intervention is the nursing priority?
A. Administering oxygen at 2L/min via nasal cannula
B. Encouraging increased fluid intake and administering IV fluids
C. Applying cold compresses to the painful joints
D. Administering meperidine (Demerol) for pain control
Correct Answer: B
Rationale: Sickle cell crisis is characterized by the clumping of sickled cells which leads to tissue
ischemia and pain. Hydration is the priority intervention because it reduces blood viscosity and prevents
further sickling of the hemoglobin. Oral and intravenous fluids help maintain circulation to the affected
tissues during an acute episode. Cold compresses should be avoided because they cause vasoconstriction
which further impairs blood flow. Pain management is vital, but meperidine is generally avoided in
pediatrics due to the risk of seizures.
2. A child is admitted with a suspected diagnosis of Wilms tumor. Which action should the nurse strictly
avoid during the physical assessment?
A. Measuring the child’s blood pressure
B. Assessing the child’s femoral pulses
C. Auscultating the child’s breath sounds
D. Palpating the child’s abdomen
,Correct Answer: D
Rationale: Wilms tumor, or nephroblastoma, is a firm and encapsulated mass located in the kidney area.
Palpating the abdomen can cause the protective capsule to rupture and spread cancerous cells
throughout the peritoneum. A sign should be placed at the head of the bed to alert all staff to avoid
abdominal palpation. Monitoring blood pressure is actually required as the tumor can cause
hypertension due to increased renin. Pre-operative care focuses on safety and preparing the family for
the surgical removal of the kidney.
3. The nurse is providing discharge instructions to the parents of a child with Hemophilia A. Which activity
should the nurse recommend as safest for this child?
A. Playing on a local soccer team
B. Joining a youth wrestling club
C. Participating in swimming lessons
D. Attending a skateboarding camp
Correct Answer: C
Rationale: Children with hemophilia are at significant risk for internal bleeding and joint damage from
physical trauma. Swimming is a non-contact sport that strengthens muscles without putting excessive
stress or impact on the joints. High-contact sports like wrestling or soccer increase the risk of
hemorrhage and should be discouraged. Parents should be taught to recognize early signs of
hemarthrosis such as joint stiffness or tingling. Safety equipment like helmets and padding should be
worn during any allowed physical activity to prevent injury.
4. A toddler is hospitalized for chemotherapy to treat leukemia. Which laboratory finding would require the
nurse to implement neutropenic precautions?
A. A White Blood Cell (WBC) count of 6,000/mm3
, B. A Hemoglobin level of 10.2 g/dL
C. A Platelet count of 150,000/mm3
D. An Absolute Neutrophil Count (ANC) of 450/mm3
Correct Answer: D
Rationale: Neutropenia occurs when the absolute neutrophil count drops below 500/mm3, significantly
increasing the risk of life-threatening infection. In this state, the child’s immune system is unable to
mount a normal inflammatory response to pathogens. Precautions include strict handwashing,
prohibiting fresh flowers or fruit in the room, and avoiding sick visitors. The nurse should also monitor
the child’s temperature frequently for any signs of fever which is a medical emergency. While low
hemoglobin and platelets are common in leukemia, the low ANC is the direct trigger for these specific
isolation protocols.
5. The nurse is educating the parents of a child with Cystic Fibrosis (CF) about the administration of
pancreatic enzymes. Which statement indicates the parents understand the teaching?
A. I will give the enzymes once a day in the morning.
B. I will mix the enzyme beads with the child’s hot oatmeal.
C. I will give the enzymes with every meal and snack.
D. I will make sure the child chews the enzyme capsules thoroughly.
B. I will give the enzymes with every meal and snack.
Correct Answer: C
Rationale: Children with Cystic Fibrosis have a deficiency of pancreatic enzymes which prevents the
proper digestion of fats and proteins. Enzymes must be taken with every meal and snack to ensure
nutrient absorption and prevent steatorrhea. If the child cannot swallow the capsules, the beads can be
