Nursing Elites

1. A nurse is teaching the parents of a toddler about the signs and symptoms of lead poisoning. Which symptom should the nurse emphasize?

• A. Abdominal pain
• B. Constipation
• C. Irritability
• D. Frequent urination

Correct answer: C

Rationale: Irritability is a significant symptom of lead poisoning in toddlers and should be emphasized to parents. Lead poisoning can manifest with various symptoms, but irritability is particularly common in children exposed to lead. Abdominal pain (Choice A) is not a typical symptom of lead poisoning in toddlers. While constipation (Choice B) can occur, it is less specific and less common than irritability. Frequent urination (Choice D) is not a typical symptom associated with lead poisoning in toddlers and is less relevant for parents to recognize in this context.

2. A 13-year-old girl tells the nurse at the pediatric clinic that she took a pregnancy test and it was positive. She adds that her grandfather, with whom she, her younger sisters, and her mother live, has repeatedly molested her for the past 3 years. When the nurse asks the girl if she has told this to anyone, she replies, 'Yes, but my mother doesn’t believe me.' Legally, who should the nurse notify?

• A. Police regarding a possible sex crime
• B. Healthcare provider to confirm the pregnancy
• C. Child Protective Services for immediate intervention
• D. Girl’s mother about the positive pregnancy test result

Correct answer: C

Rationale: In this scenario, the nurse should notify Child Protective Services for immediate intervention. The girl disclosed ongoing sexual abuse by her grandfather, which is a serious concern requiring immediate protection and intervention by the appropriate authorities. Child Protective Services are trained to handle cases of child abuse and neglect, ensuring the safety and well-being of the child. While notifying the police about a possible sex crime is crucial, Child Protective Services should be the first point of contact in cases of suspected child abuse due to their specialized role. Confirming the pregnancy through a healthcare provider is not the priority at this moment, as ensuring the safety of the child is paramount. Informing the girl's mother about the positive test result is not appropriate given the lack of belief in the abuse disclosure and the potential risk to the child's safety.

3. The nurse is caring for a 3-day-old girl with Down syndrome whose mother had no prenatal care. What is the priority nursing diagnosis?

• A. Imbalanced nutrition, less than body requirements related to the effects of hypotonia
• B. Deficient knowledge related to the presence of a genetic disorder
• C. Delayed growth and development related to a cognitive impairment
• D. Impaired physical mobility related to poor muscle tone

Correct answer: A

Rationale: The priority nursing diagnosis for a 3-day-old girl with Down syndrome, whose mother had no prenatal care, is imbalanced nutrition, less than body requirements related to the effects of hypotonia. Newborns with Down syndrome often experience feeding difficulties due to hypotonia, which can lead to inadequate nutrition intake. Option B is incorrect because at this age, the infant is not capable of having knowledge deficits related to a genetic disorder. Option C is incorrect as delayed growth and development are not the immediate priority in this scenario. Option D is incorrect as impaired physical mobility is not typically a priority concern for a newborn with Down syndrome.

4. After undergoing surgery using steel bar placement to correct pectus excavatum, what position should the nurse instruct the parents to avoid for the child?

• A. Semi-Fowler position.
• B. Supine position.
• C. High Fowler position.
• D. Side-lying position.

Correct answer: D

Rationale: After undergoing surgery for pectus excavatum correction with steel bar placement, the nurse should instruct the parents to avoid placing the child in a side-lying position. This position should be avoided to prevent displacement of the steel bar, which could compromise the surgical outcome. Semi-Fowler, supine, and high Fowler positions do not pose the same risk of displacing the steel bar and are generally safe and comfortable for the child in this postoperative period.

5. A parent and 4-year-old child who recently emigrated from Colombia arrive at the pediatric clinic. The child has a temperature of 102°F, is irritable, and has a runny nose. Inspection reveals a rash and several small, red, irregularly shaped spots with blue-white centers in the mouth. What illness does the nurse suspect the child has?

• A. Measles
• B. Chickenpox
• C. Fifth disease
• D. Scarlet fever

Correct answer: A

Rationale: The nurse should suspect measles in this child. The presence of a high fever, irritability, runny nose, rash, and Koplik spots (small, red spots with blue-white centers in the mouth) are classic signs of measles. Measles is a highly contagious viral illness that can lead to serious complications if not managed promptly. Chickenpox (choice B) presents with a different rash pattern and does not typically involve Koplik spots. Fifth disease (choice C) and scarlet fever (choice D) also have distinct clinical presentations and are not characterized by the specific symptoms described in this case.

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