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NUR 254 EXAM 4
Maternal and Pediatrics
Galen College of Nursing.
Actual 50 Questions and Answers
100% Guarantee Pass
This Exam contains:
➢ Actual 50 Questions and Answers ➢ 100% Guarantee Pass. ➢ Multiple-Choice (A–D). ➢ Each Question Includes The Correct Answer ➢ Expert-Verified explanation is essential in solidifying your understanding and pinpointing weak areas.
1. The nurse is caring for a child who has leukemia with a white blood cell (WBC) count of < 1000 mm. Which of the following should the nurse include in the child’s plan of care?
- Administer prescribed influenza vaccination.
- Assign the child to a room with other children
- Allow the child to play with other children who do not have a fever
- Use sterile techniques for any procedures Correct Answer: 4. Use sterile techniques for any procedures Verified Explanation: A WBC count of < 1,000/mm³ indicates severe neutropenia, placing the child at high risk for infection. Implementing sterile techniques for all procedures is crucial to minimize the risk of introducing pathogens. Live immunizations such as influenza should be avoided until immune function is improved. The child should have limited contact with others, especially groups or children with any possible illness. This is in alignment with the recommendations for immunocompromised pediatric patients.
2. The nurse is providing a teaching session to the health care staff regarding osteosarcoma. Which of the following statements by an attendee indicates a need for additional teaching?
- “A common clinical manifestation is limping if a weight-bearing limb is affected”
Verified Explanation: Palpation of the abdomen in a child suspected of having Wilm’s tumor is strictly contraindicated due to the risk of rupturing the encapsulated tumor, which can disseminate cancerous cells. This is a well-established safety precaution in pediatric oncology.
4. The nurse is caring for a 5-year-old child who has sickle cell disease (SCD). An assessment of the child includes the following: respirations 10 and unarousable. The child is currently on intravenous (IV) fluids and continuous IV morphine sulfate. Based on the assessment information, which of the following actions should the nurse take first?
- Increase the IV fluids to decrease vaso-occlusion
- Obtain a complete metabolic laboratory blood sample
- Elevate the head of the bed (HOB) to increase oxygen saturation
- Administer naloxone to reverse the effect of the morphine. Correct Answer: 4. Administer naloxone to reverse the effect of the morphine. Verified Explanation: A respiratory rate of 10/min and unarousability are signs of opioid overdose, likely due to morphine. The priority is to reverse opioid-induced
respiratory depression with naloxone, as airway and breathing take precedence over other interventions (ABC rule).
5. The nurse is admitting a child who has a vaso-occlusive sickle cell crisis. Which of the following interventions should the nurse anticipate to be prescribed for the child?
- Correction of alkalosis and reduction of energy expenditure
- Globulins and factor VIII replacement
- Hydration and pain management.
- Electrolyte replacement and administration of heparin. Correct Answer: 3. Hydration and pain management. Verified Explanation: The primary treatments for vaso-occlusive episodes in sickle cell disease are aggressive intravenous hydration (to decrease blood viscosity and facilitate movement of sickled cells) and pain control, typically with opioids. Factor VIII and globulin replacement are indicated in different hematologic conditions.
6. The nurse working in the emergency department (ED) is caring for a child who has hemophilia and developed a swollen knee after falling
- “Ferrous sulfate drops are contraindicated in infants less than 6 months of age”
- “Iron-fortified commercial formula should be given for the first 6 months of life.”
- “Iron-fortified infant cereal should be introduced to infants at 10 months” Correct Answer: 1. “Whole cow’s milk should not be given until 1 year of age with limited daily intake” Verified Explanation: The American Academy of Pediatrics recommends that cow’s milk be avoided in infants under 12 months because it is low in iron and can cause occult GI bleeding, increasing the risk of iron-deficiency anemia. After 1 year, intake should be limited to no more than 24 oz/day.
8. The nurse is assessing a child who has severe iron deficiency anemia. Which of the following assessment findings should the nurse expect to observe?
- Pallor.
- Painful swelling of the hands
- An enlarged abdomen
- Visual disturbances Correct Answer: 1. Pallor.
Verified Explanation: Pallor is a classic manifestation of anemia due to decreased oxygen- carrying capacity of the blood. Painful swelling of the hands is associated with sickle cell disease; enlarged abdomen may be seen with other conditions such as organomegaly.
9. The nurse is caring for 4-year-old child who is 36 hours postoperative following a removal of a Wilm’s tumor. Which of the following requires immediate follow up by the nurse?
- White blood cell (WBC) count of 15.0 mm
- Bowel sounds present in all 4 quadrants
- Temperature of 100.4°F that occurs 1 time in a 24-hour period
- Incision site is pink at the edges. Correct Answer: 1. White blood cell (WBC) count of 15.0 mm Verified Explanation: A WBC count of 15,000/mm³ is elevated and suggests a postoperative infection, which requires prompt follow-up intervention to prevent sepsis. Mildly elevated temperature post-op may be expected, and other findings are normal or reassuring.
- Administer opioids for pain control
- Administer hypertonic intravenous (IV) fluids Correct Answer: 1. Limit number of visitors inside the child’s room. Verified Explanation: Minimizing environmental stimuli such as light, noise, and frequent visitors can reduce agitation and prevent increases in ICP. Positioning on the side does not specifically decrease ICP, and hypertonic fluids should be administered only with a specific order.
12. The nurse is caring for a child who has Reye’s syndrome. Which of the following should the nurse include in the child’s plan of care?
- Change the child’s body position every 2 hours
- Provide the child a quiet atmosphere with dimmed lighting.
- Administer salicylates for increased temperature every 4 hours as needed (PRN)
- Assess for diplopia in both of the child’s eyes Correct Answer: 2. Provide the child a quiet atmosphere with dimmed lighting. Verified Explanation: Children with Reye’s syndrome are at risk of cerebral edema and increased ICP. Reducing stimulation helps to decrease ICP. Salicylates are
contraindicated, and frequent assessment for diplopia is less valuable for these patients.
13. The nurse is caring for a child who is suspected of having bacterial meningitis. The results of the lumbar puncture are still pending. Which of the following actions by the nurse is the priority?
- Decrease noxious olfactory stimuli
- Maintain a lighted environment
- Assessing neurological status every 2-4 hours.
- Administer morphine sulfate Correct Answer: 3. Assessing neurological status every 2-4 hours. Verified Explanation: Frequent neurological assessment allows early detection of deterioration such as increased ICP or seizures in meningitis. This is the first priority pending diagnostic confirmation.
14. The nurse is screening infants for early warning signs of cerebral palsy. Which of the following should the nurse recognize as 1 of the early warning signs of cerebral palsy?
- Evidence of head lag at age 1 month
- Failure to sit up without support by age 6 months
16. The nurse is developing a plan of care for a child diagnosed with attention-deficit hyperactivity disorder (ADHD). Which of the following information should the nurse include in the plan of care?
- Antianxiety medications and homeschooling
- Psychostimulant medications and behavior modification.
- Anticonvulsant medications and cognitive therapy
- Antidepressant medications and family therapy Correct Answer: 2. Psychostimulant medications and behavior modification. Verified Explanation: First-line treatment for ADHD includes psychostimulant medications such as methylphenidate, in conjunction with behavioral interventions. Other medication classes are not indicated.
17. The nurse preceptor is observing a newly hired nurse care for a child who has Down syndrome. Which of the following manifestations, if documented by the newly hired nurse, requires follow up by the nurse preceptor? a. Depressed nasal bridge b. Protruding tongue.
c. Large stature for chronological age d. Hyperflexibility Correct Answer: c. Large stature for chronological age Verified Explanation: Children with Down syndrome typically have a smaller than average stature. Accurate documentation of typical features is essential for appropriate monitoring and anticipatory guidance.
18. The nurse is caring for a child who had a ventricular shunt placement 24 hours ago. The child is sitting up in bed crying and has vomited a small amount on the bed linens. Which of the following actions should the nurse take first?
- Take complete set of vital signs (VS)
- Comfort the child while the linens are changed
- Administer an antiemetic as prescribed
- Complete a neurological assessment. Correct Answer: 4. Complete a neurological assessment. Verified Explanation: Vomiting after shunt placement may indicate increased ICP or shunt malfunction/infection, both neurological emergencies. A prompt neurological assessment will guide further urgent interventions.
- Checking pupil reaction every 4 hours.
- Assess for neck stiffness.
- Allowing the child to have 2 visitors at a time in the room. Correct Answer: 2. Checking pupil reaction every 4 hours. Verified Explanation: Regular monitoring of pupillary response is a critical indicator of neurological status, allowing early detection of deterioration that could indicate increased ICP or cerebral herniation.
21. The nurse is assessing a child in a coma and notes that the child has decorticate posturing. Which of the following findings should the nurse expect the child to demonstrate?
- Rigid extension with head arched back, arms extended by the sides, and legs extended
- Abnormal flexion of upper and lower extremities
- Rigid flexion with elbows, wrists and fingers flexed, and legs extended and rotated inward
- Abnormal extensions of the upper extremities and flexion of lower extremities Correct Answer: 3. Rigid flexion with elbows, wrists and fingers flexed, and legs extended and rotated inward
Verified Explanation: Decorticate posturing involves rigid flexion of the upper extremities with internal rotation and extension of the lower limbs, indicating damage to the cerebral hemispheres.
22. The nurse is admitting a toddler who is being hospitalized following a near-drowning accident/submersion injury. The child’s mother states to the nurse, “This is unnecessary. My child seems perfectly fine.” What is an appropriate response for the nurse to provide to the mother?
- “Complications can still occur with your child.”
- “It is important to observe your child for the development of seizure activity”
- “We are required by law to admit your child for observation”
- “Your child will need extra oxygen for the next 24 to 48 hours” Correct Answer: 1. “Complications can still occur with your child.” Verified Explanation: Submersion injuries can result in delayed pulmonary edema or neurological symptoms; therefore, observation is medically justified even if the child initially appears well.
Verified Explanation: Children with myelomeningocele have a high association with latex allergy; using latex-free equipment decreases the risk of anaphylactic reactions. The sac should be kept moist, not allowed to dry out.
25. The school nurse is instructing a school-age child who has diabetes mellitus (type 1). The child participates in soccer practice 3 afternoons a week. Which of the following statements by the child indicates a correct understanding of how to prevent hypoglycemia during practice?
- “I will eat twice the amount I normally eat at lunchtime”
- “I will drink a diet beverage 10 minutes prior to activity”
- “I will take my prescribed insulin at noontime rather than in the morning”
- “I will eat a small box of raisins or a cup of juice before soccer practice.” Correct Answer: 4. “I will eat a small box of raisins or a cup of juice before soccer practice.” Verified Explanation: A carbohydrate-rich snack prior to physical activity is recommended to prevent hypoglycemia in children with Type 1 diabetes. This is supported by clinical diabetes guidelines and pediatric endocrinology recommendations.
- The nurse is preparing discharge instructions for a child who has precocious puberty. Which of the following should the nurse include in the teaching?
- Explain the importance for the child to have peers of the same age.
- Advise the parents to decrease social activities with the opposite sex
- Advise the parents to consider birth control for their child
- Counsel parents that there is no treatment currently for this disorder Correct Answer: 1. Explain the importance for the child to have peers of the same age. Verified Explanation: Children with precocious puberty experience physical changes earlier than their peers, which can lead to psychosocial stress. Encouraging peers of the same age helps the child maintain normal social interactions and healthy emotional development. Options 2 and 3 are not standard recommendations, while option 4 is incorrect because treatment options such as GnRH analogs are available.
27. The nurse is teaching a 10-year-old child and the parents about scoliosis and treatment options. Which of the following should the nurse include when teaching about scoliosis?
- Use of a brace will slow the progression of scoliosis for most clients.
- The Milwaukee brace does not include a neck ring
- By adolescence, most children outgrow this condition
