Nursing Elites

1. A child with a cardiac malformation associated with left-to-right shunting. What does this type of congenital disorder lead to primarily?

• A. Elevated hematocrit
• B. Severe growth retardation
• C. Clubbing of the fingers and toes
• D. Increased blood flow to the lungs

Correct answer: D

Rationale: Left-to-right shunting in a cardiac malformation results in increased blood flow to the lungs. This increased blood flow can lead to pulmonary hypertension and heart failure if left untreated. Elevated hematocrit (Choice A) is not a characteristic directly associated with left-to-right shunting. Severe growth retardation (Choice B) is not a typical manifestation of this type of congenital disorder. Clubbing of the fingers and toes (Choice C) is more commonly seen in conditions like chronic respiratory or cardiac diseases, not specifically with left-to-right shunting and associated cardiac malformations.

2. A 4-year-old child is brought to the emergency department with a suspected fracture. What is the priority nursing action?

• A. Immobilize the affected limb
• B. Apply ice to the affected area
• C. Elevate the affected limb
• D. Check the child's neurovascular status

Correct answer: A

Rationale: The priority nursing action when a child with a suspected fracture is brought to the emergency department is to immobilize the affected limb. Immobilization helps prevent further injury until a fracture is confirmed or ruled out. Applying ice or elevating the limb may be necessary interventions but should come after immobilizing the limb. Checking the child's neurovascular status is important but should follow immobilization to ensure no further harm is done during the assessment.

3. The nurse is assessing a 3-year-old boy whose parents brought him to the clinic when they noticed that the right side of his abdomen was swollen. What finding would suggest this child has a neuroblastoma?

• A. The child has a maculopapular rash on his palms.
• B. The parents report that their son is vomiting and not eating well.
• C. The parents report that their son is irritable and not gaining weight.
• D. Auscultation reveals wheezing with diminished lung sounds.

Correct answer: B

Rationale: Vomiting and poor appetite can be symptoms of neuroblastoma, a malignancy that affects the adrenal glands and sympathetic nervous system. A maculopapular rash on the palms (Choice A) is not typically associated with neuroblastoma. Irritability and poor weight gain (Choice C) may be non-specific findings and do not specifically point towards neuroblastoma. Auscultation findings of wheezing with diminished lung sounds (Choice D) are more indicative of respiratory conditions rather than neuroblastoma.

4. A nurse is assessing a 2-year-old child with suspected Down syndrome. What characteristic physical feature is the nurse likely to observe?

• A. Epicanthal folds
• B. Webbed neck
• C. Enlarged head
• D. Polydactyly

Correct answer: A

Rationale: Epicanthal folds are a distinctive physical feature commonly observed in individuals with Down syndrome. These are horizontal skin folds that cover the inner corners of the eyes. Webbed neck (choice B) is not typically associated with Down syndrome but can be seen in conditions like Turner syndrome. Enlarged head (choice C) is not a characteristic feature of Down syndrome; however, individuals with hydrocephalus may present with this finding. Polydactyly (choice D) is the presence of extra fingers or toes, which is not a typical feature of Down syndrome.

5. A 12-month-old infant has become immunosuppressed during a course of chemotherapy. When preparing the parents for the infant’s discharge, what information should the nurse give concerning the measles, mumps, and rubella (MMR) immunization?

• A. It should not be given until the infant reaches 2 years of age.
• B. Infants who are receiving chemotherapy should not be given these vaccines.
• C. It should be given to protect the infant from contracting any of these diseases.
• D. The parents should discuss this with their health care provider at the next visit.

Correct answer: B

Rationale: The correct answer is B. Live vaccines like MMR should not be given to immunosuppressed infants because their weakened immune systems may not handle the vaccine safely. Choice A is incorrect as delaying the MMR vaccine until the infant reaches 2 years of age does not address the issue of immunosuppression. Choice C is incorrect because administering live vaccines to an immunosuppressed individual could lead to serious complications. Choice D is incorrect as immediate action is required to prevent potential harm to the immunosuppressed infant.

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