Nursing Elites

1. A 2-year-old child who was admitted to the hospital for further surgical repair of a clubfoot is standing in the crib, crying. The child refuses to be comforted and calls for the mother. As the nurse approaches the crib to provide morning care, the child screams louder. Knowing that this behavior is typical of the stage of protest, what is the most appropriate nursing intervention?

• A. Use comforting measures while holding the child.
• B. Fill the basin with water and proceed to bathe the child.
• C. Sit by the crib and bathe the child later when the anxiety decreases.
• D. Postpone the bath for a day because a child this upset should not be traumatized further.

Correct answer: C

Rationale: During the stage of protest, children may exhibit distress and cling to familiar figures, resisting interactions with others. The most appropriate nursing intervention is to sit by the crib, offer comfort, and wait until the child's anxiety decreases before proceeding with bathing. This approach allows the child to feel supported and gradually transition to accepting care. Choice A is incorrect because forcing comfort may escalate the child's distress. Choice B is inappropriate as it disregards the child's emotional state and rushes into the bathing procedure. Choice D is not ideal as it suggests delaying care for an extended period, which may not address the child's immediate needs for comfort and hygiene.

2. What complication of mumps is crucial for adolescents to prevent?

• A. Sterility
• B. Hypopituitarism
• C. Decreased libido
• D. Decreased androgens

Correct answer: A

Rationale: The correct answer is A, Sterility. Mumps can lead to sterility, particularly in adolescent males, highlighting the significance of vaccination to prevent this serious complication. While hypopituitarism (choice B) can be a potential complication of mumps, it is not as crucial to prevent in adolescents compared to the risk of sterility. Choices C and D, Decreased libido and Decreased androgens, are not direct complications of mumps and are not the primary concerns for adolescents in relation to mumps prevention.

3. Which of the following findings would indicate altered mental status in a small child?

• A. Recognition of the parents
• B. Fright at the EMT-B's presence
• C. Lack of attention to the EMT-B's presence
• D. Consistent eye contact with the EMT-B

Correct answer: C

Rationale: In small children, altered mental status can manifest as a lack of attention to the presence of unfamiliar individuals, such as the EMT-B. This lack of engagement may indicate confusion, disorientation, or impaired cognitive function. Choices A, B, and D are incorrect as recognizing parents, exhibiting fear, or maintaining consistent eye contact do not necessarily indicate altered mental status. Recognizing parents is a normal response, fear can be a typical reaction to unfamiliar situations, and making eye contact may be a sign of curiosity or comfort rather than a reflection of mental status.

4. A nurse is teaching a class about immunizations to members of a grammar school’s Parent-Teachers Association. Which childhood disease is the nurse discussing when explaining that it is a viral disease that starts with malaise and a highly pruritic rash that begins on the abdomen, spreads to the face and proximal extremities, and can result in grave complications?

• A. Rubella
• B. Rubeola
• C. Chickenpox
• D. Scarlet fever

Correct answer: C

Rationale: The correct answer is C, Chickenpox (varicella). Chickenpox is a viral disease characterized by a highly pruritic rash that typically starts on the abdomen and then spreads to other parts of the body, including the face and proximal extremities. It can lead to complications such as pneumonia and encephalitis. Rubella (German measles) presents with a mild rash and swollen lymph nodes; Rubeola (measles) also presents with a rash but starts on the face before spreading downwards; Scarlet fever is caused by Group A Streptococcus bacteria and is characterized by a rash, fever, and sore throat.

5. Based on developmental norms for a 5-year-old child, at what apical pulse did the nurse decide to withhold a scheduled dose of digoxin (Lanoxin) elixir and notify the health care provider?

• A. 60 beats/min
• B. 70 beats/min
• C. 90 beats/min
• D. 100 beats/min

Correct answer: C

Rationale: For a 5-year-old child, an apical pulse below 90 beats/min is a reason to withhold digoxin. Digoxin is a medication commonly used to treat heart conditions, and its administration is based on heart rate parameters. A pulse rate below 90 beats/min indicates bradycardia. In pediatric patients, bradycardia below this threshold may be a sign of toxicity or potential adverse effects of digoxin, necessitating withholding the medication and informing the healthcare provider. Choices A, B, and D are incorrect as they represent pulse rates above the threshold for withholding digoxin in a 5-year-old child.

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