Nursing Elites

1. What disease should be suspected in a 3-day-old infant presenting with abdominal distention, vomiting, and failure to pass meconium?

• A. Pyloric stenosis
• B. Intussusception
• C. Hirschsprung disease
• D. Celiac disease

Correct answer: C

Rationale: Hirschsprung disease should be suspected in a newborn with abdominal distention, vomiting, and failure to pass meconium. This condition arises from a congenital absence of nerve cells in a portion of the colon, leading to severe constipation and intestinal obstruction. Pyloric stenosis typically presents with non-bilious projectile vomiting in the first few weeks of life. Intussusception classically manifests with sudden onset of colicky abdominal pain and currant jelly stools. Celiac disease may present with chronic diarrhea, failure to thrive, and abdominal distention but is less likely in this scenario.

2. An important role of the nurse in ambulatory settings and schools is the identification of communicable diseases for treatment and the prevention of spread. What is an important component related to the first period of the contagiousness of disease?

• A. Source
• B. Causative agent
• C. Prodromal stage
• D. Constitutional symptoms

Correct answer: C

Rationale: The prodromal period is the interval between the early manifestations of the disease and the time when the overt clinical syndrome is evident. Most communicable diseases are contagious during this time. Identifying the prodromal stage is crucial for early intervention and preventing the spread of the disease. While the source and causative agent are important aspects of disease control, recognizing the early signs in the prodromal stage allows the nurse to take timely actions. Constitutional symptoms occur during the active disease phase, indicating that the child has already been contagious, and early intervention opportunities may have passed.

3. The nurse is preparing to administer a prescribed, as-needed antiemetic drug for a child diagnosed with cancer. Which action by the nurse is most appropriate?

• A. Administering the drug only if the child is nauseated.
• B. Administering the drug prophylactically before the next dose of chemotherapy.
• C. Administering the drug after the next dose of chemotherapy.
• D. Administering the drug only if the child is experiencing diarrhea.

Correct answer: B

Rationale: Administering the antiemetic prophylactically before the next dose of chemotherapy is the most appropriate action. This approach helps prevent nausea and vomiting associated with chemotherapy. Waiting until the child is already nauseated, as stated in option A, is less effective as it is reactive rather than proactive. Administering the drug after chemotherapy, as in option C, may not be as beneficial in preventing chemotherapy-induced nausea and vomiting. Option D, administering the drug only if the child is experiencing diarrhea, is not relevant to the prevention of chemotherapy-induced nausea.

4. Which teaching point should the nurse include when providing education to an adolescent client who participates in soccer regarding the plan of care for diabetes mellitus?

• A. Decreased food intake
• B. Increased doses of insulin
• C. Increased food intake
• D. Decreased doses of insulin

Correct answer: C

Rationale: The correct teaching point the nurse should include is to advise the adolescent client who participates in soccer to increase food intake. Physical activity increases glucose utilization, so adolescents with diabetes need to consume additional carbohydrates to prevent hypoglycemia during and after exercise. Choice A (Decreased food intake) is incorrect because the adolescent needs extra carbohydrates to support the increased physical activity. Choice B (Increased doses of insulin) is incorrect as the focus should be on adjusting food intake rather than insulin doses. Choice D (Decreased doses of insulin) is also incorrect as the insulin doses should be adjusted based on the increased food intake and physical activity level.

5. What changes could the school nurse implement at the school to help reduce students’ risk for developing type 2 diabetes?

• A. Increase the amount of daily physical activity.
• B. Decrease the amount of daily physical activity.
• C. Test each child’s urine monthly.
• D. Teach parents to avoid administering aspirin to their child.

Correct answer: A

Rationale: Increasing physical activity helps improve insulin sensitivity and can prevent or delay the onset of type 2 diabetes in children. Regular physical activity is a key component in managing weight and reducing the risk of chronic diseases. Decreasing physical activity (Choice B) would not be beneficial in reducing the risk of type 2 diabetes. Testing each child’s urine monthly (Choice C) is not directly related to preventing type 2 diabetes. Teaching parents to avoid administering aspirin to their child (Choice D) is important for Reye's syndrome prevention but not directly related to reducing the risk of type 2 diabetes.

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