Nursing Elites

1. In caring for a 4-year-old boy recently diagnosed with Duchenne muscular dystrophy (DMD), which characteristic of the disease is most important for the nurse to focus on during the initial teaching?

• A. Lower legs become progressively weaker, causing a waddling, unsteady gait.
• B. Growth and development have been abnormal since birth.
• C. Muscular strength can be regained with physical exercise and therapy.
• D. Respiratory dysfunction and aspiration are prime concerns at this stage of the disease.

Correct answer: A

Rationale: In Duchenne muscular dystrophy, a key characteristic is the progressive weakness in the lower legs, leading to a waddling, unsteady gait. The nurse should focus on teaching about this aspect as it helps in understanding the disease's progression and managing the symptoms effectively.

2. Immediately after birth, a newborn infant is suctioned, dried, and placed under a radiant warmer. The infant has spontaneous respirations, and the nurse assesses an apical heart rate of 80 beats/minute and respirations of 20 breaths/minute. What action should the nurse take next?

• A. Initiate positive pressure ventilation.
• B. Intervene after the one-minute Apgar assessment.
• C. Initiate CPR on the infant.
• D. Assess the infant's blood glucose level.

Correct answer: A

Rationale: A heart rate below 100 bpm in a newborn indicates bradycardia and requires intervention. Positive pressure ventilation should be initiated to improve oxygenation and help increase the infant's heart rate. This intervention is crucial to support the newborn's transition to extrauterine life and prevent further complications.

3. When assessing a client who is at 12-weeks gestation, the LPN/LVN recommends that she and her husband consider attending childbirth preparation classes. When is the best time for the couple to attend these classes?

• A. At 16 weeks gestation.
• B. At 20 weeks gestation.
• C. At 24 weeks gestation.
• D. At 30 weeks gestation.

Correct answer: D

Rationale: The best time for the couple to attend childbirth preparation classes is around 30 weeks gestation, which is during the third trimester. Attending classes at this time allows the couple to learn essential information and skills as labor and delivery are approaching, maximizing the benefit of the classes. Option A is too early in the second trimester, and the couple might forget important details by the time labor approaches. Option B is also early in the second trimester, and attending later allows for better preparation. Option C is still in the second trimester, and waiting until the third trimester provides more practical knowledge closer to delivery.

4. A mother who is breastfeeding her baby receives instructions from the nurse. Which instruction is most effective to prevent nipple soreness?

• A. Wear a cotton bra.
• B. Increase nursing time gradually.
• C. Correctly place the infant on the breast.
• D. Manually express a small amount of milk before nursing.

Correct answer: C

Rationale: The most effective instruction to prevent nipple soreness when breastfeeding is to correctly place the infant on the breast. Proper latch-on techniques ensure that the baby is properly positioned, reducing the risk of nipple soreness. When the baby is positioned correctly, they can nurse effectively without causing discomfort to the mother.

5. The parents of a 3-year-old boy with Duchenne muscular dystrophy (DMD) ask, 'How can our son have this disease? We are wondering if we should have any more children.' What information should the nurse provide these parents?

• A. This is an inherited X-linked recessive disorder, which primarily affects male children in the family.
• B. The male infant had a viral infection that went unnoticed and untreated, leading to muscle damage.
• C. The lack of the protein dystrophin in the mother can impact the XXX muscle groups of males.
• D. Spinal cord damage due to birth trauma during a breech vaginal birth weakens the muscles.

Correct answer: A

Rationale: The correct answer is A. Duchenne muscular dystrophy is an X-linked recessive disorder, meaning the gene mutation causing DMD is located on the X chromosome. Males have one X chromosome and one Y chromosome, so if the X chromosome they inherit from their mother carries the mutated gene, they will develop DMD. Females have two X chromosomes, so they are carriers of the gene but are usually not affected by the disease. Therefore, the nurse should explain to the parents that DMD is an inherited X-linked recessive disorder that primarily affects male children in the family.

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