GALEN COLLEGE OF NURSING EXAM
NUR 254
PEDIATRIC NURSING
EXAM 4 STUDY GUIDE
2026 EDITION
Galen College of Nursing
High-Yield | NCLEX-Style | Clinical Scenario–Based
✔ Pediatric respiratory disorders (asthma, bronchiolitis, croup)
✔ Pediatric gastrointestinal conditions (dehydration, diarrhea,
vomiting)
✔ Fluid & electrolyte imbalances in children
✔ Pediatric infectious diseases & isolation precautions
✔ Fever management & pediatric safety considerations
✔ Age-appropriate nursing interventions
✔ Family-centered pediatric care
✔ Clinical scenario–based questions
✔ NCLEX-style exam questions
NUR 254 Galen College Exam Iv|| 1
This study guide is an independent educational resource and is not affiliated with or endorsed by any academic institution. It is intended for exam
preparation purposes only.
, GALEN COLLEGE OF NURSING EXAM
1. A 65-year-old male client with a history of chronic obstructive pulmonary disease (COPD)
is admitted to the intensive care unit with respiratory distress. Arterial blood gas (ABG)
results are pH 7.30, PaCO2 58 mm Hg, HCO3- 32 mEq/L, and PaO2 54 mm Hg. The
client is receiving oxygen via nasal cannula at 2 L/min. Which of the following is the
priority nursing action?
A) Increase the oxygen flow rate to 4 L/min to improve saturation
B) Encourage the client to perform incentive spirometry
C) Prepare for intubation and mechanical ventilation
D) Administer a prescribed dose of albuterol via nebulizer – Correct answer
2. The nurse is caring for a client who is 12 hours post-opt from a total hip arthroplasty. The
client reports sudden onset of shortness of breath and chest pain. The nurse assesses
tachycardia, tachypnea, and a blood pressure of 90/60 mm Hg. Which diagnostic test
should the nurse anticipate being ordered first?
A) Chest x-ray
B) D-dimer assay
C) Computed tomography pulmonary angiography (CTPA) – Correct answer
D) Ventilation-perfusion (V/Q) scan
3. A client with type 1 diabetes mellitus is brought to the emergency department
unconscious. Capillary blood glucose is 24 mg/dL. Which intervention is the priority?
A) Administer 1 mg of glucagon intramuscularly
B) Start an intravenous infusion of D5W at 100 mL/hr
C) Administer 50 mL of 50% dextrose intravenously – Correct answer
D) Check the client's hemoglobin A1C level
4. The nurse is assessing a client with suspected syndrome of inappropriate antidiuretic
hormone (SIADH). Which laboratory finding would the nurse expect to see?
A) Hypernatremia
B) Decreased serum osmolality – Correct answer
C) Elevated serum creatinine
D) Hypokalemia
5. A client is admitted with a diagnosis of acute pancreatitis. Which assessment finding is
the most critical and requires immediate intervention?
A) Abdominal distention
B) Gray-Turner sign
C) Hypocalcemia manifesting as tetany – Correct answer
D) Presence of Cullen’s sign
NUR 254 Galen College Exam Iv|| 2
This study guide is an independent educational resource and is not affiliated with or endorsed by any academic institution. It is intended for exam
preparation purposes only.
, GALEN COLLEGE OF NURSING EXAM
6. The nurse is teaching a client with newly diagnosed hypertension about lifestyle
modifications. Which statement by the client indicates a need for further teaching?
A) "I will limit my alcohol intake to no more than two drinks per day."
B) "I will try to lose weight by increasing my physical activity."
C) "I should aim to consume at least 4 grams of sodium per day." – Correct answer
D) "I will include more fruits and vegetables in my diet."
7. A client with end-stage renal disease (ESRD) is scheduled for hemodialysis. The nurse
observes that the client’s fistula has a palpable thrill and a bruit. Which action by the
nurse is most appropriate?
A) Document the findings as normal
B) Elevate the arm above the level of the heart
C) Notify the physician immediately regarding the bruit
D) Apply a warm compress to the site – Correct answer
8. The nurse is caring for a client with a chest tube connected to a water-seal drainage
system. Which finding indicates a possible complication of the chest tube system?
A) Fluctuation of the fluid level in the water-seal chamber
B) Continuous bubbling in the suction control chamber
C) Continuous bubbling in the water-seal chamber – Correct answer
D) Presence of drainage in the collection chamber
9. A client with heart failure is prescribed furosemide (Lasix). The nurse should monitor the
client for which electrolyte imbalance as a potential side effect of the medication?
A) Hyperkalemia
B) Hypokalemia – Correct answer
C) Hypermagnesemia
D) Hypernatremia
10. A 24-year-old client is admitted to the emergency department following a motor vehicle
accident. The client has an open fracture of the tibia and fibula. The nurse observes that
the client’s breath is fruity and the client is confused. Which condition is the most likely
cause of these symptoms?
A) Alcoholic ketoacidosis
B) a
C) Starvation ketosis
D) Thyroid storm – Correct answer
11. The nurse is caring for a client with a diagnosis of myasthenia gravis. Which medication
should the nurse have readily available in case of a myasthenic crisis?
A) Neostigmine (Prostigmin) – Correct answer
B) Atropine sulfate
NUR 254 Galen College Exam Iv|| 3
This study guide is an independent educational resource and is not affiliated with or endorsed by any academic institution. It is intended for exam
preparation purposes only.
, GALEN COLLEGE OF NURSING EXAM
C) Edrophonium (Tensilon)
D) Pyridostigmine (Mestinon)
12. Which of the following clients is at highest risk for developing pressure injuries?
A) A 30-year-old postpartum client
B) A 75-year-old client with diabetes and peripheral vascular disease – Correct
answer
C) A 45-year-old client recovering from a cholecystectomy
D) A 22-year-old client with a fractured femur
13. The nurse is monitoring a client receiving a transfusion of packed red blood cells. Fifteen
minutes into the transfusion, the client reports flank pain and chills. The nurse notes dark
urine in the Foley catheter bag. What is the priority nursing action?
A) Slow the rate of the transfusion
B) Administer prescribed antipyretics
C) Stop the transfusion immediately and keep the IV line open with normal saline –
Correct answer
D) Obtain a urine sample for culture
14. A client is admitted with a diagnosis of deep vein thrombosis (DVT). The client is
prescribed heparin therapy. Which laboratory test is used to monitor the effectiveness of
heparin therapy?
A) Prothrombin time (PT)
B) International normalized ratio (INR)
C) Activated partial thromboplastin time (aPTT) – Correct answer
D) Platelet count
15. The nurse is providing discharge instructions to a client taking warfarin (Coumadin).
Which statement by the client indicates understanding of the teaching?
A) "I will take aspirin for my headaches."
B) "I will eat plenty of green leafy vegetables."
C) "I will have my INR checked regularly." – Correct answer
D) "I can double my dose if I miss one."
16. A client with Addison’s disease is experiencing an Addisonian crisis. Which clinical
manifestation would the nurse expect to assess?
A) Hyperkalemia and hyponatremia – Correct answer
B) Hypokalemia and hypernatremia
C) Hyperglycemia and hypertension
D) Hypocalcemia and hypomagnesemia
17. The nurse is caring for a client with a diagnosis of meningitis. Which assessment finding
indicates a positive Kernig’s sign?
NUR 254 Galen College Exam Iv|| 4
This study guide is an independent educational resource and is not affiliated with or endorsed by any academic institution. It is intended for exam
preparation purposes only.
NUR 254
PEDIATRIC NURSING
EXAM 4 STUDY GUIDE
2026 EDITION
Galen College of Nursing
High-Yield | NCLEX-Style | Clinical Scenario–Based
✔ Pediatric respiratory disorders (asthma, bronchiolitis, croup)
✔ Pediatric gastrointestinal conditions (dehydration, diarrhea,
vomiting)
✔ Fluid & electrolyte imbalances in children
✔ Pediatric infectious diseases & isolation precautions
✔ Fever management & pediatric safety considerations
✔ Age-appropriate nursing interventions
✔ Family-centered pediatric care
✔ Clinical scenario–based questions
✔ NCLEX-style exam questions
NUR 254 Galen College Exam Iv|| 1
This study guide is an independent educational resource and is not affiliated with or endorsed by any academic institution. It is intended for exam
preparation purposes only.
, GALEN COLLEGE OF NURSING EXAM
1. A 65-year-old male client with a history of chronic obstructive pulmonary disease (COPD)
is admitted to the intensive care unit with respiratory distress. Arterial blood gas (ABG)
results are pH 7.30, PaCO2 58 mm Hg, HCO3- 32 mEq/L, and PaO2 54 mm Hg. The
client is receiving oxygen via nasal cannula at 2 L/min. Which of the following is the
priority nursing action?
A) Increase the oxygen flow rate to 4 L/min to improve saturation
B) Encourage the client to perform incentive spirometry
C) Prepare for intubation and mechanical ventilation
D) Administer a prescribed dose of albuterol via nebulizer – Correct answer
2. The nurse is caring for a client who is 12 hours post-opt from a total hip arthroplasty. The
client reports sudden onset of shortness of breath and chest pain. The nurse assesses
tachycardia, tachypnea, and a blood pressure of 90/60 mm Hg. Which diagnostic test
should the nurse anticipate being ordered first?
A) Chest x-ray
B) D-dimer assay
C) Computed tomography pulmonary angiography (CTPA) – Correct answer
D) Ventilation-perfusion (V/Q) scan
3. A client with type 1 diabetes mellitus is brought to the emergency department
unconscious. Capillary blood glucose is 24 mg/dL. Which intervention is the priority?
A) Administer 1 mg of glucagon intramuscularly
B) Start an intravenous infusion of D5W at 100 mL/hr
C) Administer 50 mL of 50% dextrose intravenously – Correct answer
D) Check the client's hemoglobin A1C level
4. The nurse is assessing a client with suspected syndrome of inappropriate antidiuretic
hormone (SIADH). Which laboratory finding would the nurse expect to see?
A) Hypernatremia
B) Decreased serum osmolality – Correct answer
C) Elevated serum creatinine
D) Hypokalemia
5. A client is admitted with a diagnosis of acute pancreatitis. Which assessment finding is
the most critical and requires immediate intervention?
A) Abdominal distention
B) Gray-Turner sign
C) Hypocalcemia manifesting as tetany – Correct answer
D) Presence of Cullen’s sign
NUR 254 Galen College Exam Iv|| 2
This study guide is an independent educational resource and is not affiliated with or endorsed by any academic institution. It is intended for exam
preparation purposes only.
, GALEN COLLEGE OF NURSING EXAM
6. The nurse is teaching a client with newly diagnosed hypertension about lifestyle
modifications. Which statement by the client indicates a need for further teaching?
A) "I will limit my alcohol intake to no more than two drinks per day."
B) "I will try to lose weight by increasing my physical activity."
C) "I should aim to consume at least 4 grams of sodium per day." – Correct answer
D) "I will include more fruits and vegetables in my diet."
7. A client with end-stage renal disease (ESRD) is scheduled for hemodialysis. The nurse
observes that the client’s fistula has a palpable thrill and a bruit. Which action by the
nurse is most appropriate?
A) Document the findings as normal
B) Elevate the arm above the level of the heart
C) Notify the physician immediately regarding the bruit
D) Apply a warm compress to the site – Correct answer
8. The nurse is caring for a client with a chest tube connected to a water-seal drainage
system. Which finding indicates a possible complication of the chest tube system?
A) Fluctuation of the fluid level in the water-seal chamber
B) Continuous bubbling in the suction control chamber
C) Continuous bubbling in the water-seal chamber – Correct answer
D) Presence of drainage in the collection chamber
9. A client with heart failure is prescribed furosemide (Lasix). The nurse should monitor the
client for which electrolyte imbalance as a potential side effect of the medication?
A) Hyperkalemia
B) Hypokalemia – Correct answer
C) Hypermagnesemia
D) Hypernatremia
10. A 24-year-old client is admitted to the emergency department following a motor vehicle
accident. The client has an open fracture of the tibia and fibula. The nurse observes that
the client’s breath is fruity and the client is confused. Which condition is the most likely
cause of these symptoms?
A) Alcoholic ketoacidosis
B) a
C) Starvation ketosis
D) Thyroid storm – Correct answer
11. The nurse is caring for a client with a diagnosis of myasthenia gravis. Which medication
should the nurse have readily available in case of a myasthenic crisis?
A) Neostigmine (Prostigmin) – Correct answer
B) Atropine sulfate
NUR 254 Galen College Exam Iv|| 3
This study guide is an independent educational resource and is not affiliated with or endorsed by any academic institution. It is intended for exam
preparation purposes only.
, GALEN COLLEGE OF NURSING EXAM
C) Edrophonium (Tensilon)
D) Pyridostigmine (Mestinon)
12. Which of the following clients is at highest risk for developing pressure injuries?
A) A 30-year-old postpartum client
B) A 75-year-old client with diabetes and peripheral vascular disease – Correct
answer
C) A 45-year-old client recovering from a cholecystectomy
D) A 22-year-old client with a fractured femur
13. The nurse is monitoring a client receiving a transfusion of packed red blood cells. Fifteen
minutes into the transfusion, the client reports flank pain and chills. The nurse notes dark
urine in the Foley catheter bag. What is the priority nursing action?
A) Slow the rate of the transfusion
B) Administer prescribed antipyretics
C) Stop the transfusion immediately and keep the IV line open with normal saline –
Correct answer
D) Obtain a urine sample for culture
14. A client is admitted with a diagnosis of deep vein thrombosis (DVT). The client is
prescribed heparin therapy. Which laboratory test is used to monitor the effectiveness of
heparin therapy?
A) Prothrombin time (PT)
B) International normalized ratio (INR)
C) Activated partial thromboplastin time (aPTT) – Correct answer
D) Platelet count
15. The nurse is providing discharge instructions to a client taking warfarin (Coumadin).
Which statement by the client indicates understanding of the teaching?
A) "I will take aspirin for my headaches."
B) "I will eat plenty of green leafy vegetables."
C) "I will have my INR checked regularly." – Correct answer
D) "I can double my dose if I miss one."
16. A client with Addison’s disease is experiencing an Addisonian crisis. Which clinical
manifestation would the nurse expect to assess?
A) Hyperkalemia and hyponatremia – Correct answer
B) Hypokalemia and hypernatremia
C) Hyperglycemia and hypertension
D) Hypocalcemia and hypomagnesemia
17. The nurse is caring for a client with a diagnosis of meningitis. Which assessment finding
indicates a positive Kernig’s sign?
NUR 254 Galen College Exam Iv|| 4
This study guide is an independent educational resource and is not affiliated with or endorsed by any academic institution. It is intended for exam
preparation purposes only.
