Nursing Elites

1. A parent arrives in the emergency clinic with a 3-month-old baby who says, “My baby stopped breathing for a while.” The infant continues to have difficulty breathing, with prolonged periods of apnea. Which assessment data should alert the nurse to suspect shaken baby syndrome (SBS)?

• A. Birth occurred before 32 weeks’ gestation
• B. Lack of stridor and adventitious breath sounds
• C. Previous episodes of apnea lasting 10 to 15 seconds
• D. Retractions and use of accessory respiratory muscles

Correct answer: D

Rationale: Retractions and the use of accessory respiratory muscles can be signs of respiratory distress, which may indicate trauma such as shaken baby syndrome (SBS). Shaken baby syndrome can result in brain injury and respiratory compromise, leading to breathing difficulties. Choices A, B, and C are less likely to be associated with SBS. Birth before 32 weeks’ gestation is more related to prematurity rather than SBS. The lack of stridor and adventitious breath sounds, as well as previous episodes of apnea lasting 10 to 15 seconds, are not specific indicators of SBS.

2. The mother of a 5-year-old child with eczema is getting a check-up for her child before school starts. What will the nurse do during the visit?

• A. Change the bandage on a cut on the child’s hand.
• B. Assess the compliance with treatment regimens.
• C. Discuss systemic corticosteroid therapy.
• D. Assess the child’s fluid volume.

Correct answer: B

Rationale: During a check-up for a child with eczema, assessing compliance with treatment regimens is a key nursing intervention. This helps ensure that the child is following the prescribed treatment plan effectively, which is crucial in managing eczema and preventing flare-ups. Changing a bandage on a cut is not directly related to managing eczema. Discussing systemic corticosteroid therapy may be part of the visit, but assessing compliance is more immediate and essential. Assessing the child’s fluid volume is important for overall health assessment but not specifically related to managing eczema.

3. A parent brings an 18-month-old toddler to the clinic. The parent states, 'My child is so difficult to please, has temper tantrums, and annoys me by throwing food from the table.' What is the nurse’s best response?

• A. “Toddlers need discipline to prevent the development of antisocial behaviors.”
• B. “Toddlers are learning to assert independence, and this behavior is expected at this age.”
• C. “It is best to leave the toddler alone in the crib after calmly explaining why the behavior is unacceptable.”
• D. “This is the way a toddler expresses needs, and this behavior is acceptable during the initiative stage of development.”

Correct answer: B

Rationale: The correct answer is B: “Toddlers are learning to assert independence, and this behavior is expected at this age.” At 18 months, toddlers are in the stage of developing autonomy and independence. They may exhibit behaviors like temper tantrums and defiance as they assert their independence and test limits. It is crucial for parents and caregivers to understand that these behaviors are typical for toddlers at this age. Choice A is incorrect because discipline should be age-appropriate and focus on positive reinforcement rather than preventing antisocial behaviors. Choice C is inappropriate as leaving a toddler alone in a crib after explaining unacceptable behavior is not a recommended approach and can lead to feelings of abandonment. Choice D is inaccurate as the described behavior is more related to asserting independence rather than the initiative stage of development.

4. The healthcare provider notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of

• A. poor appetite
• B. increased potassium intake
• C. reduction of edema
• D. restriction to bed rest

Correct answer: C

Rationale: In acute glomerulonephritis, weight loss is most likely due to the reduction of edema. Edema is a common symptom of glomerulonephritis, which causes fluid retention and swelling in the body. As treatment progresses and the condition improves, the reduction of edema leads to weight loss. Choices A, B, and D are incorrect as they do not directly address the underlying pathophysiology of acute glomerulonephritis and its impact on weight loss.

5. The parents of a 2-year-old child tell the nurse that they are having difficulty disciplining their child. What is the nurse’s most appropriate response?

• A. “This is a challenging age for your child right now.”
• B. “Could you elaborate on your challenges? I’m not clear on what you mean.”
• C. “It’s important to be consistent with toddlers when they need discipline.”
• D. “I understand your concern. This phase is often referred to as the 'terrible twos'.”

Correct answer: C

Rationale: The most appropriate response for the nurse is to emphasize the importance of consistency in discipline when dealing with toddlers. Toddlers are at a stage where they are exploring boundaries and learning what behaviors are acceptable. By being consistent, parents can help reinforce these boundaries and teach appropriate behaviors effectively. Choices A, B, and D do not provide specific guidance on how to address the discipline issue effectively. While acknowledging the challenges of this age (Choice A) and empathizing with the parents (Choice D) are important, the key point in this scenario is to highlight the significance of consistency in discipline (Choice C).

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