Nursing Elites

1. When assessing a child with suspected nephrotic syndrome, what clinical manifestation is the nurse likely to observe?

• A. Jaundice
• B. Edema
• C. Hypertension
• D. Polyuria

Correct answer: B

Rationale: Edema is a hallmark clinical manifestation of nephrotic syndrome. In nephrotic syndrome, there is increased glomerular permeability leading to the loss of proteins, particularly albumin, in the urine. This results in decreased oncotic pressure, leading to fluid shifting into the interstitial spaces and causing edema. Jaundice (Choice A) is not a typical clinical manifestation of nephrotic syndrome. Hypertension (Choice C) is more commonly associated with conditions like glomerulonephritis. Polyuria (Choice D) is not a primary symptom of nephrotic syndrome; instead, patients may have reduced urine output due to fluid retention from edema.

2. A 4-year-old child is admitted to the hospital with a diagnosis of epiglottitis. What is the priority nursing intervention?

• A. Administer antibiotics
• B. Provide humidified oxygen
• C. Keep the child NPO
• D. Position the child upright

Correct answer: C

Rationale: The priority nursing intervention for a 4-year-old child admitted to the hospital with epiglottitis is to keep the child NPO (nothing by mouth). Epiglottitis is a serious condition that can lead to airway obstruction. Keeping the child NPO helps prevent further compromise of the airway and reduces the risk of aspiration. Administering antibiotics may be necessary but ensuring the airway is not compromised takes precedence. Providing humidified oxygen is important for respiratory support, but not the priority over maintaining a patent airway. Positioning the child upright can help with breathing and comfort, but it does not directly address the immediate risk of airway compromise associated with epiglottitis.

3. The nurse has developed a plan of care for a 6-year-old with muscular dystrophy. He was recently injured when he fell out of bed at home. Which intervention would the nurse suggest to prevent further injury?

• A. Recommend raising the bed's side rails throughout the day and night.
• B. Suggest having a caregiver present continuously to prevent falls from bed.
• C. Encourage the use of a loose restraint when he is in bed.
• D. Recommend raising the bed's side rails when a caregiver is not present.

Correct answer: D

Rationale: For a child with muscular dystrophy who fell out of bed, it is important to prevent further injuries. Using bed side rails when a caregiver is not present can help provide a safety measure and prevent falls. While continuous caregiver presence (choice B) may be ideal, it may not always be feasible. Recommending raising the bed's side rails throughout the day and night (choice A) may limit the child's mobility unnecessarily. Encouraging the use of a loose restraint (choice C) can be dangerous and may increase the risk of injury in case of a fall.

4. The parents of a 6-week-old infant who was born without an immune system ask a nurse why their baby is still so healthy. How should the nurse reply?

• A. Exposure to pathogens during this time can be limited.
• B. Some antibodies are produced by the infant’s colonic bacteria.
• C. Antibodies are passively received from the mother through the placenta and breast milk.
• D. Fewer antibodies are produced by the fetal thymus during the eighth and ninth months of gestation.

Correct answer: C

Rationale: The correct answer is C. Infants receive passive immunity through antibodies from the mother during pregnancy and breastfeeding, which protect them initially. Choice A is incorrect because a 6-week-old infant born without an immune system would not be able to limit exposure to pathogens effectively. Choice B is incorrect as antibodies produced by colonic bacteria are not a significant source of immunity in infants. Choice D is incorrect as the fetal thymus primarily plays a role in T cell development rather than antibody production during gestation.

5. The nurse is teaching the parents of a 1-month-old girl with Down syndrome how to maintain good health for the child. Which instruction would the nurse be least likely to include?

• A. Getting cervical radiographs between 3 and 5 years of age
• B. Adhering to the special dietary needs of the child
• C. Getting an echocardiogram before 3 months of age
• D. Monitoring for symptoms of respiratory infection

Correct answer: B

Rationale: The correct answer is B. While special dietary needs may be important for a child with Down syndrome, they are typically not the primary concern for a 1-month-old. The nurse would be least likely to focus on this aspect as immediate issues such as monitoring for congenital heart defects (echocardiogram), cervical spine abnormalities (radiographs), and respiratory infections are more critical in the early months. Adhering to dietary needs is important, but it is usually addressed as the child grows older and is not the priority during the infant stage.

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