Nursing Elites

1. A child has been diagnosed with gastroesophageal reflux disease (GERD). What position should the nurse recommend the child be placed in after eating?

• A. Supine
• B. Prone
• C. Semi-Fowler's
• D. Trendelenburg

Correct answer: C

Rationale: After eating, it is beneficial to place a child with GERD in a semi-Fowler's position. This position helps prevent reflux by keeping the child's head elevated above the stomach, reducing the chances of gastric contents flowing back into the esophagus. Placing the child supine (lying flat on their back) can worsen reflux symptoms by allowing gravity to work against the natural flow of gastric contents. Prone position (lying on the stomach) is not recommended due to the increased risk of aspiration. Trendelenburg position (feet elevated above head) is also inappropriate as it can lead to increased pressure on the abdomen, potentially worsening reflux symptoms.

2. When assessing a 10-month-old infant, what developmental milestone should the nurse expect to observe?

• A. Crawling
• B. Sitting without support
• C. Standing with assistance
• D. Pulling to a stand

Correct answer: D

Rationale: At 10 months of age, pulling to a stand is a developmental milestone that most infants can achieve. Crawling typically occurs around 6-9 months, sitting without support around 6-8 months, and standing with assistance around 7-11 months. Therefore, choices A, B, and C are not the expected developmental milestones for a 10-month-old infant.

3. A major developmental milestone of a toddler is the achievement of autonomy. What should the caregiver instruct the parents to do to enhance their toddler’s need for autonomy?

• A. Teach the child to share with others.
• B. Help the child learn society’s roles.
• C. Teach the child to accept external limits.
• D. Help the child develop internal controls.

Correct answer: D

Rationale: Toddlers are striving for autonomy during this developmental stage. Helping the child to develop internal controls, such as self-regulation and decision-making skills, enhances their sense of autonomy. Choice A, teaching the child to share, focuses more on social skills rather than autonomy. Choice B, helping the child learn society's roles, pertains to socialization rather than autonomy. Choice C, teaching the child to accept external limits, is about compliance with rules rather than fostering autonomy. Therefore, the most appropriate action to enhance a toddler's need for autonomy is to help them develop internal controls.

4. A child is admitted with extensive burns. The nurse notes burns on the child’s lips and singed nasal hairs. The nurse should suspect that the child has a(n)

• A. chemical burn
• B. inhalation injury
• C. electrical burn
• D. hot-water scald

Correct answer: B

Rationale: Burns on the lips and singed nasal hairs indicate inhalation injury, suggesting the child has inhaled hot gases or smoke. This presentation is common in cases where the respiratory tract is exposed to hot gases or smoke, leading to potential airway compromise. Choice A, chemical burn, is incorrect because there is no mention of exposure to chemicals, and the symptoms described are more indicative of inhalation injury. Choice C, electrical burn, is incorrect as there is no evidence of electrical involvement in the scenario provided. Choice D, hot-water scald, is incorrect because the presence of singed nasal hairs points more towards inhalation injury than a scald from hot water, emphasizing the need to prioritize airway management and respiratory support.

5. When caring for a 2-year-old girl who is wheezing and has difficulty breathing, which interview question would provide the most useful information related to the symptoms of the child?

• A. Inquiring about child safety in the home
• B. Asking about the temperament of the child
• C. Asking about the child's diet
• D. Asking the parents if they smoke in the home

Correct answer: D

Rationale: Asking the parents if they smoke in the home is the most relevant question as exposure to secondhand smoke can exacerbate respiratory symptoms like wheezing and difficulty breathing in children. Smoking indoors can worsen the child's condition and is crucial information for the healthcare provider to assess and address. Inquiring about child safety in the home, asking about the child's temperament, and questioning the child's diet are important aspects of care but are not directly linked to the immediate respiratory symptoms the child is experiencing.

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