Nursing Elites

1. An 18-month-old was brought to the emergency department by her mother, who states, 'I think she broke her arm.' The child is sent for a radiograph to confirm the fracture. Additional assessment of the child leads the nurse to suspect possible child abuse. Which type of fracture would the radiograph most likely reveal?

• A. Plastic deformity.
• B. Buckle fracture.
• C. Spiral fracture.
• D. Greenstick fracture.

Correct answer: C

Rationale: A spiral fracture is characterized by a twisting injury, often indicating child abuse due to the mechanism involved. This type of fracture is commonly seen in non-accidental trauma cases. Plastic deformity is not typically seen on radiographs but refers to a change in the shape of a bone without breaking. Buckle fractures are incomplete fractures commonly seen in children due to their softer bones. Greenstick fractures are also incomplete fractures, but they do not typically raise suspicion of child abuse as spiral fractures do.

2. What is a common finding that the nurse can identify in most children with symptomatic cardiac malformations?

• A. Mental retardation
• B. Inherited genetic factors
• C. Delayed physical growth
• D. Clubbing of the fingertips

Correct answer: C

Rationale: Delayed physical growth is a common finding in most children with symptomatic cardiac malformations. This occurs due to inadequate oxygenation and nutrient supply to tissues as a result of the cardiac defect. Mental retardation (Choice A) is not typically associated with cardiac malformations unless there are complications affecting brain function. Inherited genetic factors (Choice B) may contribute to the development of cardiac malformations but are not a direct common finding in affected children. Clubbing of the fingertips (Choice D) is more commonly associated with chronic respiratory or cardiac conditions, not specifically cardiac malformations in children.

3. The nurse is counseling a young couple who, in 2 months, are having their third baby. The nurse uses Von Bertalanffy's general system theory applied to families to analyze the family structure. Which best describes the main emphasis of this theory and its application to family dynamics?

• A. It emphasizes the family as a system with interdependent, interacting parts that endure over time to ensure the survival, continuity, and growth of its components.
• B. It emphasizes the social system of the family, such as the organization or structure of the family and how the structure relates to the function.
• C. It emphasizes the developmental stages that all families go through, beginning with marriage; the longitudinal career of the family is also known as the family life cycle.
• D. It addresses the way families respond to stress and how the family copes with the stress as a group and how each individual member copes.

Correct answer: A

Rationale: Von Bertalanffy's general system theory applied to families emphasizes the family as a system with interdependent, interacting parts that endure over time to ensure the survival, continuity, and growth of its components. This perspective views the family as a dynamic entity where each member's actions and behaviors impact the overall functioning of the family unit. Choice B is incorrect because it focuses more on the social aspects of family structure rather than the systemic view provided by Von Bertalanffy's theory. Choice C is incorrect as it pertains more to the family life cycle theory, which is different from the general system theory. Choice D is incorrect as it addresses stress response within families, a concept not central to Von Bertalanffy's general system theory.

4. What is important to include in discharge instructions for a child who has had a tonsillectomy?

• A. Encourage the child to gargle with salt water
• B. Encourage fluid intake
• C. Provide the child with hard candy
• D. Apply heat to the neck

Correct answer: B

Rationale: Encouraging fluid intake is essential post-tonsillectomy to keep the throat moist, aid in healing, and prevent dehydration. Gargling with salt water may irritate the surgical site and is typically avoided to prevent discomfort and irritation. Providing hard candy can be harmful as it may cause trauma to the surgical area and should be avoided to prevent injury. Applying heat to the neck is not recommended as it can increase swelling and discomfort in the surgical region. Therefore, the correct instruction is to encourage fluid intake.

5. During an assessment, a nurse is examining the skin of a child with cellulitis. What would the nurse expect to find?

• A. Red, raised hair follicles
• B. Warmth at skin disruption site
• C. Papules progressing to vesicles
• D. Honey-colored exudate

Correct answer: B

Rationale: The correct answer is B: 'Warmth at skin disruption site.' Cellulitis is characterized by localized warmth at the site of skin disruption, which indicates an infection. Choice A, 'Red, raised hair follicles,' is more typical of folliculitis. Choice C, 'Papules progressing to vesicles,' is suggestive of conditions like herpes simplex virus infections. Choice D, 'Honey-colored exudate,' is associated with impetigo, not cellulitis. When assessing cellulitis, nurses should primarily look for warmth, erythema, edema, and tenderness at the affected site.

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