Nursing Elites

1. A child is brought to the clinic after tripping over a rock. The child states, 'I twisted my ankle,' and is given a diagnosis of a sprain. What intervention is most important for the nurse to include in the discharge instructions for this child?

• A. For the first 24 hours, apply ice for 20 minutes and then remove for 60 minutes.
• B. Bed rest with the leg elevated for 36 hours.
• C. May take an NSAID for pain as needed.
• D. Use a compression dressing for 72 hours.

Correct answer: A

Rationale: The correct intervention for a sprained ankle is to apply ice for 20 minutes every hour for the first 24 hours, then remove for 60 minutes to prevent tissue damage. This regimen helps reduce swelling and pain. Bed rest with the leg elevated for an extended period (36 hours) may lead to stiffness and decreased range of motion. While NSAIDs can be used for pain, they may not be necessary if pain is manageable with ice and rest. Using a compression dressing for 72 hours continuously may impede proper circulation and delay healing by restricting blood flow.

2. What behavior does the nurse anticipate when feeding a newborn with choanal atresia?

• A. Chokes during feeding
• B. Experiences swallowing challenges
• C. Lacks hunger cues
• D. Takes about half of the feeding

Correct answer: D

Rationale: When feeding a newborn with choanal atresia, the nurse can anticipate that the infant may take only part of the feeding before pausing for air. This is due to the fact that infants with choanal atresia struggle to breathe through their nose while feeding. Choice A is incorrect as choking typically involves a more severe airway obstruction. Choice B is incorrect because difficulty swallowing is not the primary concern in choanal atresia. Choice C is incorrect as the issue is not related to hunger cues but rather the physiological challenges associated with breathing while feeding.

3. The healthcare provider notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of

• A. poor appetite
• B. increased potassium intake
• C. reduction of edema
• D. restriction to bed rest

Correct answer: C

Rationale: In acute glomerulonephritis, weight loss is most likely due to the reduction of edema. Edema is a common symptom of glomerulonephritis, which causes fluid retention and swelling in the body. As treatment progresses and the condition improves, the reduction of edema leads to weight loss. Choices A, B, and D are incorrect as they do not directly address the underlying pathophysiology of acute glomerulonephritis and its impact on weight loss.

4. 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.

5. A 2-year-old child with a diagnosis of hemophilia is admitted to the hospital. What should the nurse include in the care plan?

• A. Encourage participation in contact sports
• B. Use a soft toothbrush for oral care
• C. Administer nonsteroidal anti-inflammatory drugs
• D. Administer aspirin for pain

Correct answer: B

Rationale: The correct answer is to use a soft toothbrush for oral care. Children with hemophilia have a decreased ability to form blood clots, leading to prolonged bleeding. Using a soft toothbrush helps prevent trauma to the gums and oral mucosa, reducing the risk of bleeding. Encouraging participation in contact sports (Choice A) is contraindicated in hemophiliac patients due to the high risk of injury and bleeding. Administering nonsteroidal anti-inflammatory drugs (Choice C) and aspirin (Choice D) should be avoided in hemophilia as they can further increase the risk of bleeding due to their antiplatelet effects.

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