GCU NSG 434 Exam 3 – Nursing Care of Children – (2026)
Actual Questions & Answers — 80 Questions and Answers
Already Graded A+ Premium Exam Tested And Verified
Subject Area GCU NSG 434 Exam 3 – Nursing Care of Children – (2026) Actual Questions
& Answers
Description Comprehensive examination on GCU NSG 434 Exam 3 – Nursing Care of
Children – (2026) Actual Questions & Answers.
Expected Grade A+
Total Questions 80
Duration 3 hours
Learning Outcomes 1. Demonstrate mastery of core concepts
Accreditation Aligned with US university standards.
Page 1
,1. A pediatric nurse is evaluating a child with a history of recurrent respiratory
infections, failure to thrive, and steatorrhea. Genetic testing reveals a mutation in the
CFTR gene. The nurse understands that the pathophysiology of this condition
involves impaired chloride transport leading to thick secretions. Which of the
following best explains the relationship between the genetic defect and the clinical
manifestations?
A. Defective CFTR protein causes increased sodium reabsorption, leading to dehydration of
airway surface liquid and impaired mucociliary clearance.
B. Mutation in CFTR leads to absent chloride secretion, causing reduced water content in
secretions, resulting in thick mucus that obstructs ducts and airways.
C. CFTR dysfunction increases bicarbonate transport, altering pH of secretions and
promoting bacterial colonization.
D. The defect results in excessive chloride reabsorption, drawing water into cells and causing
cellular swelling and inflammation.
Answer: B. Mutation in CFTR leads to absent chloride secretion, causing reduced
water content in secretions, resulting in thick mucus that obstructs ducts and
airways.
The CFTR mutation impairs chloride secretion, reducing water content in secretions,
making them thick and viscous. This leads to airway obstruction, pancreatic duct
blockage, and malabsorption. Option A describes increased sodium reabsorption (not
correct); C involves bicarbonate (secondary); D is opposite (chloride reabsorption is not
increased).
Page 2
,2. A nurse is assessing a child with suspected increased intracranial pressure (ICP).
The nurse notes that the child exhibits a high-pitched cry, setting sun sign, and
bradycardia. Which of the following physiological mechanisms primarily contributes
to the bradycardia observed in this condition?
A. Direct compression of the medulla oblongata leading to parasympathetic outflow
activation.
B. Ischemia of the vasomotor center triggering a sympathetic surge followed by baroreceptor
reflex.
C. Increased ICP causing cerebral edema and subsequent release of adenosine, which slows
heart rate.
D. Cushing reflex: hypertension and bradycardia due to medullary ischemia and sympathetic
activation.
Answer: D. Cushing reflex: hypertension and bradycardia due to medullary
ischemia and sympathetic activation.
The Cushing reflex (hypertension, bradycardia, irregular respirations) is a late sign of
increased ICP. It results from medullary ischemia stimulating sympathetic
vasoconstriction (hypertension) and baroreceptor-mediated bradycardia. A is incorrect
because direct compression would cause more varied effects; B is reversed; C is not a
primary mechanism.
3. A child with acute lymphoblastic leukemia (ALL) is receiving high-dose
methotrexate therapy. The nurse monitors for signs of methotrexate toxicity. Which
of the following laboratory findings would be most indicative of early
methotrexate-induced nephrotoxicity?
A. Elevated serum creatinine and decreased urine output within 24 hours of infusion.
B. Hypokalemia and metabolic alkalosis due to tubular dysfunction.
C. Hypercalcemia and hyperphosphatemia from tumor lysis syndrome.
D. Elevated liver transaminases and prolonged prothrombin time.
Answer: A. Elevated serum creatinine and decreased urine output within 24 hours
of infusion.
Methotrexate is excreted renally and can precipitate in renal tubules, causing acute
kidney injury. Early signs include rising creatinine and oliguria. B is not typical; C is
tumor lysis syndrome (not directly methotrexate toxicity); D indicates hepatotoxicity,
which is less acute.
Page 3
, 4. A nurse is caring for a child with diabetic ketoacidosis (DKA). The child's initial
serum potassium is 4.8 mEq/L. After initiating insulin therapy, the nurse anticipates
a shift in potassium levels. Which of the following best explains the expected change
and the nursing intervention required?
A. Potassium will increase due to insulin-induced cellular release; monitor for hyperkalemia
and prepare calcium gluconate.
B. Potassium will decrease as insulin drives potassium into cells; replace potassium when
level falls below 5.0 mEq/L.
C. Potassium will remain stable because DKA is associated with total body potassium
depletion despite normal serum levels.
D. Potassium will decrease due to dilution from fluid resuscitation; no intervention needed
unless symptomatic.
Answer: B. Potassium will decrease as insulin drives potassium into cells; replace
potassium when level falls below 5.0 mEq/L.
Insulin promotes cellular uptake of potassium, causing serum potassium to fall.
Although initial serum K+ may be normal/high due to acidosis, total body potassium is
depleted. Replacement is indicated when K+ drops below 5.0 mEq/L (some protocols
use 5.5). A is opposite; C is true but does not address the shift; D is incorrect.
5. A child with a ventriculoperitoneal (VP) shunt presents with fever, headache, and
altered mental status. The nurse suspects a shunt infection. Which of the following
cerebrospinal fluid (CSF) findings would be most consistent with a VP shunt
infection?
A. Elevated glucose, low protein, and few white blood cells.
B. Low glucose, elevated protein, and pleocytosis with neutrophil predominance.
C. Normal glucose, elevated protein, and lymphocytic pleocytosis.
D. Low glucose, normal protein, and mononuclear cell predominance.
Answer: B. Low glucose, elevated protein, and pleocytosis with neutrophil
predominance.
Shunt infections typically cause bacterial meningitis, with CSF showing low glucose,
high protein, and neutrophilic pleocytosis. A is inconsistent (elevated glucose is not
typical); C suggests viral or fungal; D is not typical for bacterial infection.
Page 4
Actual Questions & Answers — 80 Questions and Answers
Already Graded A+ Premium Exam Tested And Verified
Subject Area GCU NSG 434 Exam 3 – Nursing Care of Children – (2026) Actual Questions
& Answers
Description Comprehensive examination on GCU NSG 434 Exam 3 – Nursing Care of
Children – (2026) Actual Questions & Answers.
Expected Grade A+
Total Questions 80
Duration 3 hours
Learning Outcomes 1. Demonstrate mastery of core concepts
Accreditation Aligned with US university standards.
Page 1
,1. A pediatric nurse is evaluating a child with a history of recurrent respiratory
infections, failure to thrive, and steatorrhea. Genetic testing reveals a mutation in the
CFTR gene. The nurse understands that the pathophysiology of this condition
involves impaired chloride transport leading to thick secretions. Which of the
following best explains the relationship between the genetic defect and the clinical
manifestations?
A. Defective CFTR protein causes increased sodium reabsorption, leading to dehydration of
airway surface liquid and impaired mucociliary clearance.
B. Mutation in CFTR leads to absent chloride secretion, causing reduced water content in
secretions, resulting in thick mucus that obstructs ducts and airways.
C. CFTR dysfunction increases bicarbonate transport, altering pH of secretions and
promoting bacterial colonization.
D. The defect results in excessive chloride reabsorption, drawing water into cells and causing
cellular swelling and inflammation.
Answer: B. Mutation in CFTR leads to absent chloride secretion, causing reduced
water content in secretions, resulting in thick mucus that obstructs ducts and
airways.
The CFTR mutation impairs chloride secretion, reducing water content in secretions,
making them thick and viscous. This leads to airway obstruction, pancreatic duct
blockage, and malabsorption. Option A describes increased sodium reabsorption (not
correct); C involves bicarbonate (secondary); D is opposite (chloride reabsorption is not
increased).
Page 2
,2. A nurse is assessing a child with suspected increased intracranial pressure (ICP).
The nurse notes that the child exhibits a high-pitched cry, setting sun sign, and
bradycardia. Which of the following physiological mechanisms primarily contributes
to the bradycardia observed in this condition?
A. Direct compression of the medulla oblongata leading to parasympathetic outflow
activation.
B. Ischemia of the vasomotor center triggering a sympathetic surge followed by baroreceptor
reflex.
C. Increased ICP causing cerebral edema and subsequent release of adenosine, which slows
heart rate.
D. Cushing reflex: hypertension and bradycardia due to medullary ischemia and sympathetic
activation.
Answer: D. Cushing reflex: hypertension and bradycardia due to medullary
ischemia and sympathetic activation.
The Cushing reflex (hypertension, bradycardia, irregular respirations) is a late sign of
increased ICP. It results from medullary ischemia stimulating sympathetic
vasoconstriction (hypertension) and baroreceptor-mediated bradycardia. A is incorrect
because direct compression would cause more varied effects; B is reversed; C is not a
primary mechanism.
3. A child with acute lymphoblastic leukemia (ALL) is receiving high-dose
methotrexate therapy. The nurse monitors for signs of methotrexate toxicity. Which
of the following laboratory findings would be most indicative of early
methotrexate-induced nephrotoxicity?
A. Elevated serum creatinine and decreased urine output within 24 hours of infusion.
B. Hypokalemia and metabolic alkalosis due to tubular dysfunction.
C. Hypercalcemia and hyperphosphatemia from tumor lysis syndrome.
D. Elevated liver transaminases and prolonged prothrombin time.
Answer: A. Elevated serum creatinine and decreased urine output within 24 hours
of infusion.
Methotrexate is excreted renally and can precipitate in renal tubules, causing acute
kidney injury. Early signs include rising creatinine and oliguria. B is not typical; C is
tumor lysis syndrome (not directly methotrexate toxicity); D indicates hepatotoxicity,
which is less acute.
Page 3
, 4. A nurse is caring for a child with diabetic ketoacidosis (DKA). The child's initial
serum potassium is 4.8 mEq/L. After initiating insulin therapy, the nurse anticipates
a shift in potassium levels. Which of the following best explains the expected change
and the nursing intervention required?
A. Potassium will increase due to insulin-induced cellular release; monitor for hyperkalemia
and prepare calcium gluconate.
B. Potassium will decrease as insulin drives potassium into cells; replace potassium when
level falls below 5.0 mEq/L.
C. Potassium will remain stable because DKA is associated with total body potassium
depletion despite normal serum levels.
D. Potassium will decrease due to dilution from fluid resuscitation; no intervention needed
unless symptomatic.
Answer: B. Potassium will decrease as insulin drives potassium into cells; replace
potassium when level falls below 5.0 mEq/L.
Insulin promotes cellular uptake of potassium, causing serum potassium to fall.
Although initial serum K+ may be normal/high due to acidosis, total body potassium is
depleted. Replacement is indicated when K+ drops below 5.0 mEq/L (some protocols
use 5.5). A is opposite; C is true but does not address the shift; D is incorrect.
5. A child with a ventriculoperitoneal (VP) shunt presents with fever, headache, and
altered mental status. The nurse suspects a shunt infection. Which of the following
cerebrospinal fluid (CSF) findings would be most consistent with a VP shunt
infection?
A. Elevated glucose, low protein, and few white blood cells.
B. Low glucose, elevated protein, and pleocytosis with neutrophil predominance.
C. Normal glucose, elevated protein, and lymphocytic pleocytosis.
D. Low glucose, normal protein, and mononuclear cell predominance.
Answer: B. Low glucose, elevated protein, and pleocytosis with neutrophil
predominance.
Shunt infections typically cause bacterial meningitis, with CSF showing low glucose,
high protein, and neutrophilic pleocytosis. A is inconsistent (elevated glucose is not
typical); C suggests viral or fungal; D is not typical for bacterial infection.
Page 4
