Nursing Elites

1. A healthcare professional is reviewing the clinical records of infants and children with cardiac disorders who developed heart failure. What did the healthcare professional determine is the last sign of heart failure?

• A. Tachypnea
• B. Tachycardia
• C. Peripheral edema
• D. Periorbital edema

Correct answer: C

Rationale: Peripheral edema is often the last sign of heart failure in infants and children as it indicates significant fluid retention and circulatory compromise. Tachypnea (Choice A) and tachycardia (Choice B) are early signs of heart failure due to the body's compensatory mechanisms. Periorbital edema (Choice D) can occur in heart failure but is not typically the last sign; it is more commonly associated with renal or hepatic dysfunction.

2. A child with a diagnosis of gastroesophageal reflux disease (GERD) is being discharged. What dietary instructions should the nurse provide?

• A. Avoid spicy foods
• B. Avoid gluten
• C. Avoid high-fat foods
• D. Avoid dairy products

Correct answer: C

Rationale: The correct dietary instruction for a child with GERD is to avoid high-fat foods. High-fat foods can relax the lower esophageal sphincter, leading to increased reflux. While avoiding gluten may be necessary for individuals with gluten sensitivity or celiac disease, it is not a standard recommendation for GERD. Avoiding spicy foods and dairy products may help some individuals with GERD, but the most crucial dietary advice is to avoid high-fat foods.

3. A nurse is inspecting the skin of a child with atopic dermatitis. What would the nurse expect to observe?

• A. Erythematous papulovesicular rash
• B. Dry, red, scaly rash with lichenification
• C. Pustular vesicles with honey-colored exudates
• D. Hypopigmented oval scaly lesions

Correct answer: B

Rationale: In atopic dermatitis, the characteristic presentation includes a dry, red, scaly rash with lichenification. This appearance is due to chronic inflammation and scratching. Choice A is incorrect as erythematous papulovesicular rash is more indicative of conditions like contact dermatitis. Choice C is incorrect as pustular vesicles with honey-colored exudates are seen in impetigo. Choice D is incorrect as hypopigmented oval scaly lesions are more characteristic of tinea versicolor.

4. The nurse is caring for a 15-year-old boy who has sustained burn injuries. The nurse observes the burn developing a purplish color with discharge and a foul odor. The nurse suspects which infection?

• A. Burn wound cellulitis.
• B. Invasive burn cellulitis.
• C. Burn impetigo.
• D. Staphylococcal scalded skin syndrome.

Correct answer: B

Rationale: Invasive burn cellulitis is characterized by the burn developing a dark brown, black, or purplish color with discharge and a foul odor. This description aligns with the symptoms observed in the 15-year-old boy. Burn wound cellulitis (Choice A) typically presents with erythema, edema, warmth, and tenderness at the burn site, without the characteristic changes seen in this case. Burn impetigo (Choice C) is a superficial infection characterized by honey-colored crusts, not consistent with the purplish color and foul odor described. Staphylococcal scalded skin syndrome (Choice D) is a condition caused by exotoxins produced by Staphylococcus aureus, leading to widespread desquamation of the skin, but it does not typically present with the specific findings mentioned in the scenario.

5. A child with a diagnosis of diabetes insipidus is admitted to the hospital. What is the priority nursing intervention?

• A. Administering insulin
• B. Monitoring fluid balance
• C. Administering diuretics
• D. Monitoring vital signs

Correct answer: B

Rationale: The correct answer is monitoring fluid balance. In a child with diabetes insipidus, the primary concern is excessive urination and fluid loss, which can lead to dehydration. Monitoring fluid balance is crucial to prevent dehydration and maintain electrolyte balance. Administering insulin (Choice A) is not indicated in diabetes insipidus, as this condition is not related to insulin deficiency. Administering diuretics (Choice C) should be avoided as it can exacerbate fluid loss in a child already at risk for dehydration. While monitoring vital signs (Choice D) is important, the priority intervention in this situation is monitoring fluid balance to prevent complications associated with dehydration.

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