Nursing Elites

1. During a routine health screening for a 1-year-old child, what is the most critical topic for the nurse to discuss with the parents?

• A. the potential hazards of accidents
• B. appropriate nutrition now that the child has been weaned from breastfeeding
• C. toilet training
• D. how to purchase appropriate shoes now that the child is walking

Correct answer: A

Rationale: During a routine health screening for a 1-year-old child, the most critical topic for the nurse to discuss with the parents is the potential hazards of accidents. Accidents are the primary source of injury in children and can be life-threatening. Discussions about appropriate nutrition should have been addressed during the weaning process, while the purchase of appropriate shoes is important but not life-threatening. Toilet training typically begins around 2 years of age, so 1 year of age is too early to discuss it. Therefore, the focus should be on educating parents about accident prevention to ensure the child's safety and well-being.

2. As part of a routine health screening, the nurse notes the play of a 2-year-old child. Which of the following is an example of age-appropriate play at this age?

• A. builds towers with several blocks
• B. tries to color within the lines
• C. says "Mine!"? when playing with toys
• D. tries to jump rope

Correct answer: C

Rationale: For a 2-year-old child, saying 'Mine!' when playing with toys is an example of age-appropriate play. Toddlers at this age are possessive and asserting their sense of ownership. Building towers with blocks and trying to color within the lines involve more advanced motor skills and cognitive abilities that are typically not fully developed in a 2-year-old. Jumping rope requires coordination and balance beyond what a 2-year-old can usually achieve. Therefore, choices A, B, and D are not considered age-appropriate plays for a 2-year-old child.

3. A client has just returned from surgery where a femoral-popliteal bypass was performed. The nurse has assessed the client and is unable to feel a pulse at either the dorsalis pedis or the posterior tibial sites of the left foot. The foot feels warm, and the color is pink. What action should the nurse perform next to prevent ischemia?

• A. Notify the physician immediately
• B. Obtain a Doppler device to check for pulses, and notify the physician if they are still absent
• C. Wait 30 minutes and recheck the pulses
• D. Document the finding

Correct answer: B

Rationale: The nurse should immediately obtain a Doppler device and recheck the pulses. The dorsalis pedis and posterior tibial pulses can be difficult to assess and might need to be verified with a Doppler device. Since the client just had surgery with a risk of arterial insufficiency, close monitoring is crucial. If pulses are not palpable, it indicates an emergent situation requiring immediate physician notification. Waiting 30 minutes before reassessment could lead to foot ischemia. While documenting findings is essential, it should follow pulse confirmation or necessary interventions to ensure the client's foot viability.

4. A client is given an opiate drug for pain relief following general anesthesia. The client becomes extremely somnolent with respiratory depression. The physician is likely to order the administration of:

• A. naloxone (Narcan)
• B. labetalol (Normodyne)
• C. neostigmine (Prostigmin)
• D. thiothixene (Navane)

Correct answer: A

Rationale: In this scenario, the client is experiencing respiratory depression due to opiate overdose. Naloxone (Narcan) is an opioid antagonist that can rapidly reverse the effects of opiates by competitively binding to opioid receptors and displacing the opiates. This action can restore normal respiration and consciousness. Labetalol (Normodyne) is a non-selective beta-blocker used to manage hypertension, not opioid-induced respiratory depression. Neostigmine (Prostigmin) is a cholinesterase inhibitor used to reverse neuromuscular blockade, not opioid overdose. Thiothixene (Navane) is an antipsychotic medication used to manage psychotic disorders, not opioid toxicity.

5. A nurse is preparing to assess the dorsalis pedis pulse. The nurse palpates this pulse by placing the fingertips in which location?

• A. Behind the knee
• B. Lateral to the extensor tendon of the big toe
• C. In the groove between the malleolus and the Achilles tendon
• D. Below the inguinal ligament, halfway between the pubis and the anterior superior iliac spines

Correct answer: B

Rationale: The correct location to palpate the dorsalis pedis pulse is lateral to and parallel with the extensor tendon of the big toe. Choices A, C, and D describe the locations for other pulses - popliteal, posterior tibial, and femoral artery respectively. The popliteal pulse is found behind the knee, the posterior tibial pulse is located in the groove between the malleolus and the Achilles tendon, and the femoral artery is situated below the inguinal ligament, halfway between the pubis and the anterior superior iliac spines.

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