Galen NSG 3600 Exam 4 – Children's Health (2026) Actual Q&A PDF, Exams of Nursing

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Galen NSG 3600 Exam 4 – Children's Health

(2026) Actual Q&A PDF

1. The nurse is teaching a parent about ADHD. Which neurotransmitter imbalance is associated with this disorder? A) Serotonin and acetylcholine B) Dopamine and norepinephrine C) GABA and glutamate D) Histamine and melatonin Correct Answer: Dopamine and norepinephrine Rationale: ADHD is linked to imbalances in dopamine and norepinephrine, which affect attention, impulse control, and executive function. Stimulant medications increase the availability of these neurotransmitters.
2. A school‑age child with ADHD is prescribed methylphenidate. The parent asks how the dose is determined. The nurse responds that dosing is based on: A) The child’s weight B) The child’s age C) Resolution of symptoms, not weight D) A standard dose for all children Correct Answer: Resolution of symptoms, not weight Rationale: Psychostimulants for ADHD are titrated based on clinical response — reduction of core symptoms — rather than weight. The lowest effective dose is used. Weight is monitored for growth, not dosing.
3. Which behavior is most characteristic of a child with autism spectrum disorder?

Correct Answer: Environmental manipulation Rationale: ADHD management involves medication, behavioral therapy, and modifying the child’s environment (structure, routine, reduced distractions) to support success. Dietary elimination and isolation are not evidence‑based.

1. A child with autism spectrum disorder becomes distressed when the daily routine is changed. Which nursing intervention is most appropriate? A) Insist the child adapt to the new schedule immediately B) Use a visual schedule and prepare the child in advance for changes C) Place the child in time‑out until calm D) Avoid all activities to prevent distress Correct Answer: Use a visual schedule and prepare the child in advance for changes Rationale: Predictability reduces anxiety in children with ASD. Visual schedules and advance warning help the child anticipate transitions. Forcing adaptation or using punishment increases distress. 7. A child with Type 1 diabetes is ill with vomiting and fever. The parent asks if insulin should be given. The nurse’s best response is: A) “Skip the insulin until your child can eat.” B) “Never withhold insulin; check blood gl ucose and ketones frequently, and call the provider if needed.” C) “Give half the usual dose only.” D) “Switch to oral medication during the illness.” Correct Answer: “Never withhold insulin; check blood glucose and ketones frequently, and call the provid er if needed.” Rationale: During illness, insulin must be continued to prevent DKA. Blood glucose and ketones are monitored frequently, and fluids are encouraged. The provider is contacted if the child cannot retain fluids or has high ketones.

1. A child with Type 1 diabetes is planning to play soccer. The nurse teaches the child to: A) Skip insulin on game days B) Check blood glucose before, during, and after exercise C) Avoid all carbohydrates before playing D) Drink only water without any snacks Correct Answer: Check blood glucose before, during, and after exercise Rationale: Exercise can cause hypoglycemia; monitoring before, during, and after activity, adjusting carbohydrate intake, and staying hydrated are essential. Insulin should not be skipped; it may need adjustment.
2. A child with diabetic ketoacidosis (DKA) has Kussmaul respirations. The nurse understands that this breathing pattern is a compensatory mechanism for: A) Hypoglycemia B) Metabolic acidosis C) Respiratory alkalosis D) Hyperkalemia Correct Answer: Metabolic acidosis Rationale: In DKA, the body produces ketones, leading to metabolic acidosis. Kussmaul respirations (deep, rapid breathing) blow off CO₂ to raise pH. It is a classic sign of severe DKA.
3. A child with DKA is receiving IV insulin and fluids. The nurse monitors for cerebral edema, which is the most serious complication of DKA treatment. Which finding is the earliest sign? A) Polyuria B) Headache and change in level of consciousness C) Tachycardia

Rationale: When the WBC count is ≤2,000/mm³, the child is at high risk for opportunistic infections such as PCP. Prophylactic antibiotics like TMP‑SMX are standard to prevent this life‑threatening pneumonia.

13. A parent of a child with leukemia reports that the child has a fever of 101.5°F. The nurse’s priority is to: A) Administer acetaminophen and reassess in 2 hours B) Notify the provider immediately and prepare for IV antibiotics C) Apply a cooling blanket D) Encourage increased oral fluid intake Correct Answer: Notify the provider immediately and prepare for IV antibiotics Rationale: Fever in a neutropenic child is a medical emergency. Blood cultures should be drawn, and broad‑spectrum antibiotics started within 1 hour. Acetaminophen and cooling do not address the underlying risk of sepsis.

1. A nurse is examining a 2‑year‑old child ’ s eye and notes a whitish reflex in the pupil. The nurse suspects: A) Congenital cataract B) Retinoblastoma C) Allergic conjunctivitis D) Corneal abrasion Correct Answer: Retinoblastoma Rationale: Leukocoria (a white pupil reflex) is a hallmark sign of retinoblastoma, a malignant tumor of the retina. It requires immediate ophthalmologic evaluation and intervention. 15. A child is diagnosed with a Wilms tumor. The nurse should place which sign above the child’s bed? A) “NPO after midnight”

B) “Do Not Palpate Abdomen” C) “Strict hand hygiene” D) “Fall precautions” Correct Answer: “Do Not Palpate Abdomen” Rationale: Palpating a Wilms tumor can rupture the capsule and spread cancer cells. The abdomen must not be palpated; the sign alerts all healthcare providers to this critical safety precaution.

1. An adolescent reports worsening leg pain at night that is not relieved by rest. The nurse suspects: A) Growing pains B) Osteosarcoma C) Sickle cell crisis D) Juvenile idiopathic arthritis Correct Answer: Osteosarcoma Rationale: Nighttime bone pain unrelieved by rest is a classic symptom of osteosarcoma, most commonly affecting the long bones (femur, tibia) in adolescents. It is often initially misdiagnosed as growing pains.
2. A child with sickle cell disease is admitted in vaso‑occlusive crisis with severe pain. The priority nursing intervention is: A) Apply cold packs to the joints B) Administer high‑dose opioids and aggressive IV fluids as prescribed C) Restrict oral fluids D) Encourage vigorous range‑of‑motion exercises Correct Answer: Administer high‑dose opioids and aggressive IV fluids as prescribed

C) Shaving the child’s head D) Applying petroleum jelly to the scalp overnight Correct Answer: Over‑the‑counter pediculicide (permethrin) and manual nit removal Rationale: Permethrin 1% is the first‑line treatment. Manual removal of nits with a fine‑tooth comb is essential. Environmental cleaning (hot water laundry, vacuuming, sealing non‑washable items) is also required.

1. A parent asks when a child with head lice can return to school. The nurse responds: A) “After all nits are removed, even if treatment is not completed.” B) “After the first treatment is completed and live lice are no longer present.” C) “The child must stay home for 2 weeks.” D) “Only when the school nurse checks and clears the child.” C orrect Answer: “After the first treatment is completed and live lice are no longer present.” Rationale: Most schools allow return after the first pediculicide treatment is completed and no live lice are observed. Nits alone may not require exclusion. Check specific school policies.
2. A child with atopic dermatitis has intense itching. Which nursing instruction is most important to prevent skin breakdown? A) “Apply alcohol to the affected areas.” B) “Keep your child’s fingernails short and use cotton gloves at night.” C) “Bathe your child in hot water twice daily.” D) “Expose the skin to sunlight for extended periods.” Correct Answer: “Keep your child’s fingernails short and use cotton gloves at night.”

Rationale: Short nails and cotton gloves reduce skin damage from scratching. Emollients, lukewarm baths, and avoidance of triggers are also key. Alcohol and hot water dry and irritate the skin.

1. A child with moderate atopic dermatitis is experiencing a flare‑up. The nurse expects which topical medication to be prescribed? A) Topical antibiotic B) Topical corticosteroid C) Topical antifungal D) Topical anesthetic Correct Answer: Topical corticosteroid Rationale: Topical corticosteroids reduce inflammation and pruritus during flare‑ups. They are applied sparingly to affected areas. Antibiotics are used only if secondary infection is present.
2. The nurse is teaching a parent about preventing the spread of influenza. Which statement indicates correct understanding? A) “My child can return to school after 24 hours without fever, without needing the flu vaccine.” B) “I will have my child vaccinated against influenza every year.” C) “The flu is only a mild illness in children.” D) “Hand hygiene is not important for preventing the flu.” Correct Answer: “I will have my child vaccinated against influenza every year.” Rationale: The annual influenza vaccine is the most effective prevention strategy. Children should stay home until fever‑free for 24 hours without antipyretics. Influenza can be severe, especially in young children.
3. A hospitalized child with influenza is placed on droplet precautions. Which personal protective equipment is required when the nurse is within 3 feet of the child? A) N95 respirator

Rationale: Microwaving can cause uneven heating and dangerous hot spots, risking burns. The safest method is to warm the bottle in a container of warm water and test the temperature on the inner wrist before feeding.

1. A toddler is brought to the emergency department with burns on the buttocks that appear as if the child was dipped in hot water. The nurse suspects: A) An accidental spill B) Non‑accidental trauma (inflicted immersion burn) C) A chemical burn from cleaning products D) A sunburn Correct Answer: Non‑accidental trauma (inflicted immersion burn) Rationale: Symmetric, sharply demarcated burns with a “glove” or “stocking” distribution, or burns on the buttocks resembling immersion, are classic red flags for physical abuse and require mandatory reporting.
2. A nurse is providing anticipatory guidance to parents of a newborn about SIDS prevention. Which instruction is most important? A) Place the infant on the stomach to sleep B) Use a firm mattress with no soft bedding C) Keep the room very warm D) Place a soft bumper pad in the crib Correct Answer: Use a firm mattress with no soft bedding Rationale: Safe sleep recommendations include supine positioning, a firm mattress, and no loose bedding, pillows, or bumper pads. Overheating and soft surfaces increase SIDS risk.
3. A parent asks about car seat safety for a 12‑month‑old infant who weighs 22 pounds. The nurse responds that the child should:

A) Transition to a forward‑facing car seat immediately B) Remain in a rear‑facing car seat until at least age 2 years C) Use a booster seat with a lap belt only D) Sit in the front seat with the airbag turned on Correct Answer: Remain in a rear‑facing car seat until at least age 2 years Rationale: The American Academy of Pediatrics recommends rear‑facing until at least age 2 or until the child outgrows the seat ’ s height/weight limits. Rear‑facing provides optimal protection for the head and neck.

1. The nurse is teaching a parent about preventing burns in the home. The hot water heater should be set no higher than: A) 140°F (60°C) B) 130°F (54°C) C) 120°F (49°C) D) 110°F (43°C) Correct Answer: 120°F (49°C) Rationale: Water heater temperatures at or below 120°F significantly reduce the risk of scald burns in children. Hot water can cause third‑degree burns in seconds at higher temperatures.
2. A mother reports that her 2‑year‑old was found with an open bottle of household cleaner. The child is alert. What is the priority nursing action? A) Induce vomiting with syrup of ipecac B) Give the child a glass of milk to neutralize the poison C) Call the Poison Control Center immediately D) Take the child to the emergency department without calling

1. A child with Type 1 diabetes is experiencing hypoglycemia during soccer practice. Which snack should the parent provide? A) A candy bar with nuts B) 4 ounces of juice or glucose tablets C) A diet soda D) A slice of cheese Correct Answer: 4 ounces of juice or glucose tablets Rationale: For conscious hypoglycemia, 15 grams of fast‑acting carbohydrate (4 oz juice, glucose tablets) should be given and blood glucose rechecked in 15 minutes. Candy bars contain fat that slows absorption; cheese has no carbohydrate.
2. A child with DKA has a potassium level of 3.2 mEq/L. The nurse should anticipate which intervention before starting the insulin infusion? A) Start the insulin infusion as ordered B) Administer IV potassium replacement as prescribed C) Give oral potassium supplements D) Restrict all potassium intake Correct Answer: Administer IV potassium replacement as prescribed Rationale: Insulin drives potassium into cells; starting insulin with hypokalemia can cause life‑threatening arrhythmias. Potassium must be replaced intravenously before insulin therapy begins.
3. A parent asks why their child with leukemia has petechiae. The nurse explains that petechiae are caused by: A) Low red blood cell count B) Low platelet count C) Low white blood cell count D) High platelet count

Correct Answer: Low platelet count Rationale: Thrombocytopenia (low platelets) impairs clotting and causes tiny capillary hemorrhages called petechiae. Anemia causes pallor and fatigue; leukopenia increases infection risk.

1. A child with sickle cell disease develops acute chest syndrome. The nurse anticipates administering: A) Antibiotics and blood transfusion B) Antipyretics only C) Diuretics D) Anticoagulants Correct Answer: Antibiotics and blood transfusion Rationale: Acute chest syndrome is treated with oxygen, incentive spirometry, antibiotics, and often blood transfusion to improve oxygenation. It is a life‑threatening complication requiring aggressive management.
2. A child with hemophilia is being discharged. Which activity should the nurse recommend? A) Football B) Swimming C) Skateboarding D) Boxing Correct Answer: Swimming Rationale: Non‑contact sports like swimming are safe and promote joint health without significant bleeding risk. Contact sports carry high risk of injury and hemorrhage.

Correct Answer: Hypothyroidism Rationale: Children with Down syndrome have an increased risk of hypothyroidism and should have thyroid function tested regularly. They also require screening for congenital heart disease, hearing/vision loss, and atlantoaxial instability.

1. A child with Down syndrome is being evaluated for participation in sports. Which screening is essential due to the risk of spinal cord injury? A) Echocardiogram B) Thyroid function tests C) Cervical spine X‑ray for atlantoaxial instability D) Bone density scan Correct Answer: Cervical spine X‑ray for atlantoaxial instability Rationale: Atlantoaxial instability is common in Down syndrome and can lead to spinal cord compression during activities that hyperextend or flex the neck. Screening X‑rays are recommended before participation in Special Olympics or contact sports.
2. A child with ADHD is taking a stimulant medication. The nurse should monitor for which common side effect? A) Weight gain and hypersomnia B) Appetite suppression and insomnia C) Bradycardia and hypotension D) Polyuria and polydipsia Correct Answer: Appetite suppression and insomnia Rationale: Stimulants commonly cause decreased appetite and difficulty sleeping. Growth parameters should be monitored regularly. The medication is given early in the day to minimize sleep disturbance.

1. A parent of a child with ADHD reports that the child has developed motor tics since starting medication. The nurse should: A) Reassure the parent that this is normal and will resolve without intervention B) Notify the provider, as the medication may need to be adjusted C) Increase the dose of the stimulant D) Discontinue the medication immediately without consulting the provider Correct Answer: Notify the provider, as the medication may need to be adjusted Rationale: Stimulants can exacerbate or unmask tics. The provider should be notified for possible dose adjustment or change to a non‑stimulant medication. The medication should not be stopped abruptly without guidance.

2. A child with autism is hospitalized. The nurse should incorporate which communication strategy? A) Use abstract language and metaphors B) Use short, concrete sentences and visual aids C) Speak loudly and rapidly D) Avoid making eye contact entirely Correct Answer: Use short, concrete sentences and visual aids Rationale: Children with ASD often respond better to concrete language and visual supports. Avoiding eye contact entirely is not necessary; the nurse should respect the child’s comfort level.

3. A child with new‑onset Type 1 diabetes is being discharged. The nurse teaches the family to check urine ketones when blood glucose is: A) Below 70 mg/dL B) Above 240 mg/dL or during illness C) Only before meals