Nursing Elites

1. A school-age child is 2 hours postoperative following a tonsillectomy. Which of the following actions should the nurse include in the plan of care?

• A. Place a heating pad at the surgical site.
• B. Encourage the child to cough every 2 hours.
• C. Administer analgesics to the child on a regular schedule.
• D. Apply an ice collar to the child's neck.

Correct answer: D

Rationale: After a tonsillectomy, applying an ice collar to the child's neck helps decrease pain and swelling. Heat should be avoided as it can increase bleeding. Encouraging coughing may increase the risk of bleeding. Administering analgesics on a regular schedule is essential for pain management, but the immediate postoperative period may require additional interventions like ice collar application.

2. Which statement best reflects a top-down approach to the evaluation process?

• A. OT focuses on evaluating the child's poor performance in hand skills
• B. OT conducts an assessment to determine a motor age for fine motor and gross motor skills
• C. OT initiates by interviewing the family about routines, interests, and daily habits
• D. OT starts by assessing muscle tone, postural control, and range of motion

Correct answer: C

Rationale: A top-down evaluation approach in occupational therapy begins with understanding the child's daily life, family routines, interests, and habits to ensure that the therapy provided is relevant and meaningful within the child's natural environment. By initiating the evaluation process with family interviews to gather contextual information, the occupational therapist gains a comprehensive view of the child's life, which allows for a more holistic and client-centered approach. Choice A focuses solely on the child's poor performance in hand skills, which is more characteristic of a bottom-up approach. Choice B mentions determining a motor age, which is not necessarily aligned with a top-down assessment. Choice D emphasizes physical assessments like muscle tone and range of motion, which are important but do not capture the essence of a top-down approach that considers the child's environment and routines.

3. A child is being assessed for acute poststreptococcal glomerulonephritis (APSGN). Which of the following findings should the nurse expect?

• A. Hematuria
• B. Polyuria
• C. Hypertension
• D. Diarrhea

Correct answer: C

Rationale: In acute poststreptococcal glomerulonephritis (APSGN), hypertension is a common finding due to fluid retention and decreased kidney function. This condition often presents with hypertension as a result of sodium and water retention, as well as reduced glomerular filtration rate. Hematuria, not diarrhea, is also a common symptom of APSGN due to inflammation and damage to the glomeruli. Polyuria, an increase in urine output, is not a typical finding in APSGN unless severe kidney damage leads to decreased urine concentrating ability.

4. What is the priority nursing intervention when caring for a neonate born with bladder exstrophy?

• A. Measuring intake and output
• B. Inserting a Foley catheter
• C. Covering the defect with sterile plastic wrap
• D. Palpating the bladder mass to ensure urine is expelled

Correct answer: C

Rationale: The priority nursing intervention when caring for a neonate born with bladder exstrophy is to cover the defect with sterile plastic wrap. This intervention helps prevent infection and maintains a moist environment, promoting optimal healing and reducing the risk of complications.

5. When discussing the correction of hypospadias in a newborn, what does the nurse explain about this condition?

• A. No intervention is required as the defect will correct itself over time.
• B. Surgical repair of hypospadias is typically performed before 18 months of age.
• C. Corrective surgery is commonly postponed until preschool age.
• D. Repairing the defect does not increase the risk of testicular cancer.

Correct answer: B

Rationale: Hypospadias is a congenital condition where the opening of the urethra is on the underside of the penis. Surgical repair is the primary treatment for hypospadias and is usually recommended to be done before 18 months of age. This timing is preferred for optimal cosmetic and functional outcomes. Waiting until preschool age for corrective surgery may increase the complexity of the procedure and potential complications. Correcting hypospadias does not impact the risk of testicular cancer.

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