NURS 307 | NURS307 Exam 4: Pediatrics - WCU
Updated and Latest Questions and Correct
Answers with Rationale
1. A 10-year-old child is admitted to the hospital in a vaso-occlusive sickle cell crisis. Which
nursing intervention is the priority?
A. Administering high-dose intravenous antibiotics
B. Increasing intravenous and oral fluid intake
C. Applying cold compresses to the painful joints
D. Administering meperidine for pain management
Correct Answer: B
Rationale: Hydration is the priority intervention to reduce blood viscosity and prevent
further sickling. Dehydration can worsen the occlusion of small blood vessels during a
crisis. Pain management is also essential, but morphine is preferred over meperidine due
to seizure risks. Cold compresses should be avoided as they cause vasoconstriction. Oxygen
therapy is only indicated if the patient is hypoxemic.
2. A nurse is caring for a child with Hemophilia A who has a leg injury. What is the most
appropriate initial action?
A. Perform passive range of motion exercises
B. Apply pressure and ice to the injured area
C. Administer aspirin for pain relief
D. Encourage the child to walk to assess mobility
Correct Answer: B
Rationale: Immediate treatment for a bleeding episode in hemophilia involves the RICE
method. Pressure and ice promote vasoconstriction and help slow the bleeding. Aspirin is
contraindicated because it inhibits platelet aggregation and increases bleeding risk. Range
of motion exercises should only be done after the bleeding is controlled. The limb should be
elevated and immobilized to prevent further trauma.
3. Which assessment finding should the nurse prioritize in a child diagnosed with a Wilms
tumor?
A. Hypotension and bradycardia
B. Gross hematuria and painful urination
C. Abdominal mass and hypertension
,D. Generalized edema and proteinuria
Correct Answer: C
Rationale: Wilms tumor usually presents as a firm, non-tender abdominal mass that does
not cross the midline. Hypertension is common due to increased renin production from the
kidneys. It is critical never to palpate the abdomen of these patients to prevent tumor
rupture. While hematuria occurs in some cases, it is not the most definitive sign. Nurses
must place a sign above the bed stating no abdominal palpation.
4. A child with Acute Lymphoblastic Leukemia (ALL) is receiving chemotherapy and has a low
absolute neutrophil count. Which instruction is vital for the parents?
A. Limit the child’s fluid intake to prevent edema
B. Allow the child to attend school if they feel well
C. Avoid giving the child any fresh fruits or vegetables
D. Administer the live varicella vaccine immediately
Correct Answer: C
Rationale: A neutropenic diet is often recommended to reduce exposure to bacteria found
in raw foods. Immunocompromised children should avoid large crowds and public places
like schools during periods of low counts. Live vaccines are strictly contraindicated for
children undergoing chemotherapy for leukemia. Handwashing is the most effective way to
prevent infection in these patients. Any sign of fever should be reported to the provider
immediately.
5. A 4-year-old is brought to the ER with suspected epiglottitis. Which action should the nurse
avoid?
A. Placing the child in a tripod position
B. Administering humidified oxygen
C. Preparing for emergency intubation
D. Examining the throat with a tongue depressor
Correct Answer: D
Rationale: Examining the throat of a child with epiglottitis can trigger a fatal
laryngospasm. The nurse should keep the child calm and in a position of comfort, usually
sitting up. Emergency airway equipment must be kept at the bedside at all times.
Epiglottitis is a medical emergency that requires prompt antibiotic therapy. The ‘tripod
position’ is a classic sign of respiratory distress in these patients.
6. A child with Type 1 Diabetes Mellitus presents with Kussmaul respirations and fruity
breath. What is the priority intervention?
A. Administering oral glucose gel
, B. Starting an IV infusion of normal saline
C. Administering subcutaneous long-acting insulin
D. Providing a high-protein snack
Correct Answer: B
Rationale: These signs indicate Diabetic Ketoacidosis (DKA), which requires immediate
fluid resuscitation. Rehydration with isotonic fluids is the first step before starting insulin
therapy. Regular insulin is then administered via continuous intravenous infusion to lower
blood glucose. Oral glucose is used for hypoglycemia, not hyperglycemia or ketoacidosis.
Frequent monitoring of electrolytes, especially potassium, is necessary during DKA
treatment.
7. A nurse is teaching parents of a child with Cystic Fibrosis about pancreatic enzymes. When
should these be administered?
A. Once daily in the morning
B. Only when the child has fatty stools
C. With every meal and snack
D. Two hours after eating a meal
Correct Answer: C
Rationale: Pancreatic enzymes must be taken with all meals and snacks to assist with
nutrient absorption. Children with CF have blocked pancreatic ducts, preventing natural
enzymes from reaching the intestines. The dosage is usually adjusted based on the child’s
growth and stool consistency. If the child cannot swallow capsules, they can be opened and
sprinkled on acidic food like applesauce. Proper enzyme replacement prevents
malabsorption and promotes weight gain in CF patients.
8. What is the hallmark clinical manifestation of a child with intussusception?
A. Painless rectal bleeding
B. Ribbon-like, foul-smelling stools
C. Projectile vomiting after feeding
D. Currant jelly-like stools
Correct Answer: D
Rationale: Intussusception occurs when one part of the intestine telescopes into another,
causing obstruction. The mixture of blood and mucus creates the characteristic ‘currant
jelly’ stool. Patients often experience sudden, episodic abdominal pain with knee-to-chest
positioning. Ribbon-like stools are associated with Hirschsprung disease instead of
Updated and Latest Questions and Correct
Answers with Rationale
1. A 10-year-old child is admitted to the hospital in a vaso-occlusive sickle cell crisis. Which
nursing intervention is the priority?
A. Administering high-dose intravenous antibiotics
B. Increasing intravenous and oral fluid intake
C. Applying cold compresses to the painful joints
D. Administering meperidine for pain management
Correct Answer: B
Rationale: Hydration is the priority intervention to reduce blood viscosity and prevent
further sickling. Dehydration can worsen the occlusion of small blood vessels during a
crisis. Pain management is also essential, but morphine is preferred over meperidine due
to seizure risks. Cold compresses should be avoided as they cause vasoconstriction. Oxygen
therapy is only indicated if the patient is hypoxemic.
2. A nurse is caring for a child with Hemophilia A who has a leg injury. What is the most
appropriate initial action?
A. Perform passive range of motion exercises
B. Apply pressure and ice to the injured area
C. Administer aspirin for pain relief
D. Encourage the child to walk to assess mobility
Correct Answer: B
Rationale: Immediate treatment for a bleeding episode in hemophilia involves the RICE
method. Pressure and ice promote vasoconstriction and help slow the bleeding. Aspirin is
contraindicated because it inhibits platelet aggregation and increases bleeding risk. Range
of motion exercises should only be done after the bleeding is controlled. The limb should be
elevated and immobilized to prevent further trauma.
3. Which assessment finding should the nurse prioritize in a child diagnosed with a Wilms
tumor?
A. Hypotension and bradycardia
B. Gross hematuria and painful urination
C. Abdominal mass and hypertension
,D. Generalized edema and proteinuria
Correct Answer: C
Rationale: Wilms tumor usually presents as a firm, non-tender abdominal mass that does
not cross the midline. Hypertension is common due to increased renin production from the
kidneys. It is critical never to palpate the abdomen of these patients to prevent tumor
rupture. While hematuria occurs in some cases, it is not the most definitive sign. Nurses
must place a sign above the bed stating no abdominal palpation.
4. A child with Acute Lymphoblastic Leukemia (ALL) is receiving chemotherapy and has a low
absolute neutrophil count. Which instruction is vital for the parents?
A. Limit the child’s fluid intake to prevent edema
B. Allow the child to attend school if they feel well
C. Avoid giving the child any fresh fruits or vegetables
D. Administer the live varicella vaccine immediately
Correct Answer: C
Rationale: A neutropenic diet is often recommended to reduce exposure to bacteria found
in raw foods. Immunocompromised children should avoid large crowds and public places
like schools during periods of low counts. Live vaccines are strictly contraindicated for
children undergoing chemotherapy for leukemia. Handwashing is the most effective way to
prevent infection in these patients. Any sign of fever should be reported to the provider
immediately.
5. A 4-year-old is brought to the ER with suspected epiglottitis. Which action should the nurse
avoid?
A. Placing the child in a tripod position
B. Administering humidified oxygen
C. Preparing for emergency intubation
D. Examining the throat with a tongue depressor
Correct Answer: D
Rationale: Examining the throat of a child with epiglottitis can trigger a fatal
laryngospasm. The nurse should keep the child calm and in a position of comfort, usually
sitting up. Emergency airway equipment must be kept at the bedside at all times.
Epiglottitis is a medical emergency that requires prompt antibiotic therapy. The ‘tripod
position’ is a classic sign of respiratory distress in these patients.
6. A child with Type 1 Diabetes Mellitus presents with Kussmaul respirations and fruity
breath. What is the priority intervention?
A. Administering oral glucose gel
, B. Starting an IV infusion of normal saline
C. Administering subcutaneous long-acting insulin
D. Providing a high-protein snack
Correct Answer: B
Rationale: These signs indicate Diabetic Ketoacidosis (DKA), which requires immediate
fluid resuscitation. Rehydration with isotonic fluids is the first step before starting insulin
therapy. Regular insulin is then administered via continuous intravenous infusion to lower
blood glucose. Oral glucose is used for hypoglycemia, not hyperglycemia or ketoacidosis.
Frequent monitoring of electrolytes, especially potassium, is necessary during DKA
treatment.
7. A nurse is teaching parents of a child with Cystic Fibrosis about pancreatic enzymes. When
should these be administered?
A. Once daily in the morning
B. Only when the child has fatty stools
C. With every meal and snack
D. Two hours after eating a meal
Correct Answer: C
Rationale: Pancreatic enzymes must be taken with all meals and snacks to assist with
nutrient absorption. Children with CF have blocked pancreatic ducts, preventing natural
enzymes from reaching the intestines. The dosage is usually adjusted based on the child’s
growth and stool consistency. If the child cannot swallow capsules, they can be opened and
sprinkled on acidic food like applesauce. Proper enzyme replacement prevents
malabsorption and promotes weight gain in CF patients.
8. What is the hallmark clinical manifestation of a child with intussusception?
A. Painless rectal bleeding
B. Ribbon-like, foul-smelling stools
C. Projectile vomiting after feeding
D. Currant jelly-like stools
Correct Answer: D
Rationale: Intussusception occurs when one part of the intestine telescopes into another,
causing obstruction. The mixture of blood and mucus creates the characteristic ‘currant
jelly’ stool. Patients often experience sudden, episodic abdominal pain with knee-to-chest
positioning. Ribbon-like stools are associated with Hirschsprung disease instead of
