Nursing Elites

1. A nonimmunized child appears at the clinic with a visible rash. Which of the following observations indicates the child may have rubeola (measles)?

• A. Small blue-white spots are visible on the oral mucosa.
• B. The rash begins on the trunk and spreads outward.
• C. There is low-grade fever.
• D. The lesions have a "teardrop-on-a-rose-petal"? appearance.

Correct answer: A

Rationale: The presence of small blue-white spots on the oral mucosa, known as Koplik's spots, is characteristic of measles (rubeola) infection. These spots typically appear on the buccal mucosa opposite the second molars, 1-2 days before the rash onset, and last until 2 days after the rash appears. While Koplik's spots are pathognomonic for measles, their absence does not rule out the diagnosis. Therefore, choice A is the correct answer. Choices B, C, and D are incorrect because the rash pattern, presence of low-grade fever, and characteristic appearance of lesions are not specific indicators of measles infection.

2. A teacher brings a 5-year-old child to the school nurse because of a bruise under her eye. When asked about the bruise, the child responds, 'my daddy did it.' What is the nurse's initial action in this situation?

• A. Allow the child to return to class and monitor for future events that are suggestive of abuse
• B. Call the parent and request an explanation for the bruises
• C. Call the police and ask for a warrant for the parent's arrest
• D. Notify the school administrator

Correct answer: D

Rationale: In cases of suspected child abuse, the priority for the school nurse is to notify the school administrator immediately. The school administrator can then collaborate with the nurse to follow established protocols for reporting suspected abuse to the appropriate authorities. All suspicions or allegations of child abuse must be handled with sensitivity and in compliance with state laws and school policies. All other options, such as allowing the child to return to class without further action, directly contacting the parent, or involving the police without proper investigation, could potentially compromise the safety and well-being of the child and may not adhere to legal requirements for reporting suspected abuse.

3. Mr. G has been admitted to the hospital with a head injury after a 12-foot fall. Which of the following nursing interventions is most appropriate when monitoring intracranial pressure?

• A. Administer hypotonic solutions
• B. Keep the head of the bed elevated
• C. Increase the client's core body temperature to 99.9 degrees
• D. Administer corticosteroids as ordered

Correct answer: D

Rationale: Administering corticosteroids as ordered is appropriate when monitoring intracranial pressure in clients at risk of increased pressure to reduce brain tissue swelling. Elevating the head of the bed helps in managing intracranial pressure by promoting venous drainage. Administering hypertonic solutions is used to reduce brain edema and control intracranial pressure. Increasing the client's core body temperature is not recommended as it can exacerbate brain injury. Corticosteroids are not routinely used for all head injuries but may be indicated in specific cases, such as certain types of brain injuries where swelling needs to be controlled.

4. The BRAT diet is often prescribed for patients with gastroenteritis. This acronym stands for:

• A. Bananas, Rice, Applesauce, and Toast
• B. Bread, Rice, Apricots, and Tapioca
• C. Bananas, Rolls, Apricots, and Toast
• D. Bananas, Rolls, Applesauce, and Tapioca

Correct answer: A

Rationale: The BRAT diet, which stands for Bananas, Rice, Applesauce, and Toast, is commonly recommended for patients with gastroenteritis. These easily digestible foods help firm up stools due to their low fiber content and provide essential nutrients lost during vomiting and diarrhea. Choice B is incorrect because it includes apricots, which are not part of the traditional BRAT diet. Choice C is incorrect as it includes rolls, which are not typically included in the BRAT diet. Choice D is incorrect as it includes tapioca, which is not part of the traditional BRAT diet. Therefore, the correct answer is Bananas, Rice, Applesauce, and Toast.

5. Which of the following abides by the Americans with Disabilities Act of 1990?

• A. A nurse manager cannot cancel an interview with a potential employee because he has left-sided paralysis
• B. A nurse is allowed to have a leave of absence to recover after a back injury
• C. A nurse is mandated to receive 12 weeks off of work after having a baby
• D. A nurse manager must hire a nurse who uses a walker for mobility

Correct answer: A

Rationale: The Americans with Disabilities Act of 1990 prohibits discrimination against individuals with disabilities in employment practices, ensuring equal opportunities for qualified individuals. Therefore, a nurse manager cannot cancel an interview with a potential employee simply because the individual has left-sided paralysis. Doing so would be considered discriminatory under the ADA. Choices B, C, and D do not directly align with ADA requirements. Choice B involves medical leave, which can be covered under a different law; choice C refers to maternity leave, which is protected under other regulations; and choice D involves a hiring decision based on a mobility aid, not the individual's qualifications, which does not fall under ADA guidelines.

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