Nursing Elites

1. A 2-year-old girl is brought to the clinic by her 17-year-old mother. When the nurse observes that the child is drinking sweetened soda from her bottle, what information should the nurse discuss with this mother?

• A. A 2-year-old should be speaking in 2-word phrases
• B. Dental caries is associated with drinking soda
• C. Drinking soda is related to childhood obesity
• D. Toddlers should be sleeping 10 hours a night

Correct answer: B

Rationale: Dental caries are a common concern when children consume sweetened sodas regularly.

2. The nurse is caring for a 3-year-old child who has been recently diagnosed with cystic fibrosis. Which discharge instruction by the nurse is most important to promote pulmonary function?

• A. Chest physiotherapy should be performed before meals and at bedtime
• B. Cough suppressants can be used up to four times a day for relief
• C. Oxygen should be given through a nasal cannula between 4-6 L/min
• D. Exercise is discouraged in order to preserve pulmonary vital capacity

Correct answer: B

Rationale: In cystic fibrosis, thick mucus obstructs the airways, making it difficult to clear from the lungs. Cough suppressants can help reduce the discomfort associated with persistent coughing, allowing the child to cough more effectively to clear the mucus, thus promoting pulmonary function. Chest physiotherapy, not exercise, helps mobilize the mucus. Oxygen therapy may be needed but is not the most important for promoting pulmonary function in this case.

3. The parents of a 5-year-old child, recently diagnosed with celiac disease, are being educated by the healthcare provider. Which statement by the parents indicates a need for further teaching?

• A. We need to avoid giving our child any foods that contain wheat, barley, or rye
• B. Our child can still eat oats as long as they are labeled gluten-free
• C. We should read food labels carefully to check for hidden sources of gluten
• D. It’s okay for our child to have small amounts of gluten occasionally

Correct answer: D

Rationale: The correct answer is D. Children with celiac disease must strictly adhere to a gluten-free diet. Even small amounts of gluten can cause harm by triggering an immune response that damages the intestines. It is crucial for parents to understand that allowing their child to have small amounts of gluten occasionally is not safe and can lead to complications. Therefore, further teaching is needed to emphasize the importance of complete avoidance of gluten-containing foods for a child with celiac disease. Choices A, B, and C demonstrate understanding of the need to avoid gluten-containing foods and hidden sources of gluten, which are essential in managing celiac disease. Choice D is incorrect as it suggests a lax approach to the child's diet, which can be harmful in the case of celiac disease.

4. The nurse is conducting an admission assessment of an 11-month-old infant with CHF who is scheduled for repair of restenosis of coarction of the aorta that was repaired 4 days after birth. Findings include blood pressure higher in the arms than the lower extremities, pounding brachial pulses, and slightly palpable femoral pulses. What pathophysiologic mechanisms support these findings?

• A. The aortic semilunar valve obstructs blood flow into the systemic circulation
• B. The lumen of the aorta reduces the volume of the blood flow to the lower extremities
• C. The pulmonic valve prevents adequate blood volume into the pulmonary circulation
• D. An opening in the atrial septum causes a murmur due to a turbulent left-to-right shunt

Correct answer: B

Rationale: The correct answer is B. Coarctation of the aorta causes narrowing of the aorta, reducing blood flow to the lower extremities. This narrowing results in higher blood pressure in the arms compared to the lower extremities, along with stronger brachial pulses and slightly palpable femoral pulses. Choices A, C, and D are incorrect because they do not align with the pathophysiological mechanism of coarctation of the aorta, which specifically leads to reduced blood flow to the lower extremities.

5. The healthcare provider is preparing to suture a 10-year-old child with a lacerated forehead. Both parents and a 12-year-old sibling are present at the child's bedside. Which instruction best supports family involvement?

• A. While waiting for the healthcare provider, only one visitor may stay with the child.
• B. All of you should leave while the healthcare provider sutures the child's forehead.
• C. It is best if the sibling goes to the waiting room until the suturing is completed.
• D. Please decide who will stay when the healthcare provider begins suturing.

Correct answer: D

Rationale: Involving the family members in deciding who will stay when the healthcare provider begins suturing supports family involvement and helps reduce anxiety for the child. This approach respects the family's dynamics and preferences, promoting a supportive environment during the procedure.

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