Nursing Elites

1. 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.

2. A nurse is reviewing the laboratory report of a child with tetralogy of Fallot that indicates an elevated RBC count. What does the nurse identify as the cause of the polycythemia?

• A. Low tissue oxygen needs
• B. Tissue oxygen needs
• C. Diminished iron levels
• D. Hypertrophic cardiac muscle

Correct answer: B

Rationale: The correct answer is B: Tissue oxygen needs. Polycythemia occurs in response to chronic hypoxia, leading the body to increase red blood cell production to enhance oxygen delivery. In tetralogy of Fallot, a congenital heart defect that results in reduced oxygen levels in the blood, the body compensates by producing more red blood cells. Choice A is incorrect as low tissue oxygen needs would not trigger polycythemia. Choice C, diminished iron levels, is not the cause of polycythemia in this case. Choice D, hypertrophic cardiac muscle, is unrelated to the pathophysiology of polycythemia in tetralogy of Fallot.

3. The mother of an 8-year-old girl with a broken arm is the nurturer in the family. Which nursing activity should be focused on her?

• A. Teaching proper care procedures
• B. Dealing with insurance coverage
• C. Determining success of treatment
• D. Transmitting information to family members

Correct answer: A

Rationale: In this scenario, focusing on teaching the mother proper care procedures is crucial. This empowers the mother to provide appropriate care for her daughter's broken arm, promoting optimal healing. Dealing with insurance coverage (Choice B) is important but not the immediate focus for the mother. Determining the success of treatment (Choice C) is typically done by healthcare professionals, not family members. Transmitting information to family members (Choice D) may be beneficial but ensuring the primary caregiver, in this case, the mother, is well-informed and capable of providing care takes precedence.

4. The instructor is educating a group of students about myelination in a child. Which statement by the students indicates that the teaching was successful?

• A. Myelination continues into adolescence.
• B. The process occurs in a head-to-toe fashion.
• C. Myelination speeds up nerve impulses.
• D. Myelination increases the specificity and efficiency of nerve impulses.

Correct answer: B

Rationale: The correct answer is B. Myelination occurs in a cephalocaudal (head-to-toe) pattern, improving nerve function progressively. Choice A is incorrect because myelination continues beyond 4 years of age and into adolescence. Choice C is incorrect as myelination speeds up nerve impulses rather than slowing them down. Choice D is incorrect because myelination increases the specificity and efficiency of nerve impulses, making them more focused and precise.

5. A 1-month-old girl with low-set ears and severe hypotonia has been diagnosed with trisomy 18. Which nursing diagnosis would the nurse identify as most likely?

• A. Interrupted family process related to the child's diagnosis
• B. Deficient knowledge related to the genetic disorder
• C. Grieving related to the child's poor prognosis
• D. Ineffective coping related to the stress of providing care

Correct answer: C

Rationale: The most likely nursing diagnosis for a 1-month-old girl with trisomy 18, characterized by low-set ears and severe hypotonia, is 'Grieving related to the child's poor prognosis.' Trisomy 18 is associated with a poor prognosis, and families often experience grief as they come to terms with the challenges and uncertainties associated with the condition. 'Interrupted family process' may not be as relevant since the primary focus is on the child's condition. 'Deficient knowledge related to the genetic disorder' could be important but may not be the most likely initial concern, as emotional support for the family is crucial at this point. 'Ineffective coping related to the stress of providing care' is a broad diagnosis that does not specifically address the emotional response to the child's prognosis, which is the primary concern in this case.

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