Nursing Elites

1. A child with acute glomerulonephritis is in the playroom and experiences blurred vision and a headache. What action should the nurse take?

• A. Check the urine to see if hematuria has increased.
• B. Obtain the child's blood pressure and notify the healthcare provider.
• C. Obtain serum electrolytes and send urinalysis to the laboratory.
• D. Reassure the child and encourage bed rest until the headache improves.

Correct answer: B

Rationale: Blurred vision and headache in a child with acute glomerulonephritis may indicate severe hypertension, which requires immediate assessment and intervention. Blood pressure should be checked, and the healthcare provider notified.

2. What should preoperative care of a newborn with an anorectal malformation include?

• A. Frequent suctioning
• B. Gastrointestinal decompression
• C. Feedings with sterile water only
• D. Supine position with head elevated

Correct answer: C

Rationale: Preoperative care for a newborn with an anorectal malformation should include feedings with sterile water only. This approach is important to avoid complications before surgery. Gastrointestinal decompression is necessary to prevent abdominal distention and potential aspiration, making choice B incorrect. Frequent suctioning and placing the newborn in a supine position with the head elevated are not typically part of the preoperative care protocol for an anorectal malformation, thus choices A and D are incorrect.

3. The child is admitted to the hospital unit newly diagnosed with retinoblastoma. Which clinical manifestation does the nurse anticipate upon assessment?

• A. A white reflex
• B. Blue-tinged sclerae
• C. A red reflex
• D. Yellow-tinged sclerae

Correct answer: A

Rationale: The correct answer is A: A white reflex. The 'white reflex' or leukocoria is a common sign of retinoblastoma. It occurs when the light reflects off the tumor in the eye, giving the pupil a white appearance instead of the normal red reflex. Blue-tinged sclerae (choice B) and yellow-tinged sclerae (choice D) are not typical manifestations of retinoblastoma. A red reflex (choice C) is the normal reflection seen in the eye when light is shone on it and is not associated with retinoblastoma.

4. A girl, age 5 1/2 years, has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurse should recommend to her parent that the first action is to have the child evaluated for what condition?

• A. School phobia
• B. Glomerulonephritis
• C. Urinary tract infection (UTI)
• D. Attention deficit hyperactivity disorder (ADHD)

Correct answer: C

Rationale: Urinary tract infections are a common cause of sudden onset urinary incontinence in children. While school phobia and ADHD can cause behavioral changes, a medical condition like a UTI should be ruled out first.

5. During the nurse’s initial assessment of a school-age child, the child reports a pain level of 6 out of 10. The child is lying quietly in bed watching television. What action should the nurse take?

• A. Reassess the child in 15 minutes to see if the pain rating has changed
• B. Administer the prescribed analgesic
• C. Do nothing since the child appears to be resting
• D. Ask the child’s parents if they think the child is hurting

Correct answer: B

Rationale: Pain management should be based on the child’s report of pain, regardless of their activity level. Administering the prescribed analgesic is the appropriate action. Reassessing the child in 15 minutes without providing immediate pain relief may not be in the child's best interest. Doing nothing since the child appears to be resting may lead to inadequate pain management. Asking the child’s parents if they think the child is hurting does not replace the need for direct assessment and intervention by the nurse.

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