Nursing Elites

1. After a discussion with the health care provider, the parents of an infant with patent ductus arteriosus (PDA) ask the nurse to explain once again what PDA is. How should the nurse respond?

• A. The diameter of the aorta is enlarged.
• B. The wall between the right and left ventricles is open.
• C. It is a narrowing of the entrance to the pulmonary artery.
• D. It is a connection between the pulmonary artery and the aorta.

Correct answer: D

Rationale: The correct answer is D: 'It is a connection between the pulmonary artery and the aorta.' Patent ductus arteriosus (PDA) is an abnormal connection between the pulmonary artery and the aorta, which normally closes after birth. Choices A, B, and C describe different cardiac conditions and do not accurately define PDA. Choice A is incorrect because PDA does not involve the diameter of the aorta being enlarged. Choice B is incorrect because PDA does not involve the wall between the right and left ventricles being open. Choice C is incorrect because PDA is not a narrowing of the entrance to the pulmonary artery.

2. The caregiver is caring for an infant with osteogenesis imperfecta and is providing instruction on how to reduce the risk of injury. Which response from the caregiver indicates a need for further teaching?

• A. I need to avoid pushing or pulling on an arm or leg.
• B. I should carefully lift the baby by supporting the head and neck.
• C. I should not bend an arm or leg into an awkward position.
• D. We must avoid lifting the legs by the ankles to change diapers.

Correct answer: B

Rationale: Lifting the baby by supporting the head and neck can cause fractures in infants with osteogenesis imperfecta. Caregivers should avoid lifting infants in this manner due to the risk of injury. Choices A, C, and D demonstrate correct understanding of how to prevent injuries in infants with osteogenesis imperfecta by avoiding excessive force on the arms or legs, preventing awkward positions, and lifting the legs in a safer manner to change diapers.

3. What type of play does a caregiver expect when observing a toddler in a playroom with other children?

• A. Parallel
• B. Solitary
• C. Cooperative
• D. Competitive

Correct answer: A

Rationale: When observing a toddler in a playroom with other children, a caregiver would expect to witness parallel play. Parallel play is common among toddlers, where they play alongside but not directly with other children. This type of play is characterized by children engaging in similar activities near each other without interactive or cooperative play. Solitary play (Choice B) involves a child playing alone, while cooperative play (Choice C) involves children playing together towards a common goal. Competitive play (Choice D) involves activities where children compete against each other.

4. A 3-year-old child has a sudden onset of respiratory distress. The mother denies any recent illnesses or fever. You should suspect

• A. croup
• B. epiglottitis
• C. lower respiratory infection
• D. foreign body airway obstruction

Correct answer: D

Rationale: In a 3-year-old child presenting with sudden respiratory distress and no history of recent illnesses or fever, foreign body airway obstruction should be suspected. Foreign body airway obstruction commonly leads to acute respiratory distress without preceding symptoms. Croup (Choice A) typically presents with a barking cough and stridor. Epiglottitis (Choice B) often presents with high fever, drooling, and a muffled voice. Lower respiratory infection (Choice C) may manifest with symptoms such as cough, fever, and respiratory distress, but the sudden onset without fever or recent illness suggests a more acute event like foreign body airway obstruction.

5. Which of the following parameters would be LEAST reliable when assessing the perfusion status of a 2-year-old child with possible shock?

• A. distal capillary refill
• B. systolic blood pressure
• C. skin color and temperature
• D. presence of peripheral pulses

Correct answer: B

Rationale: Systolic blood pressure is the least reliable parameter when assessing the perfusion status of a 2-year-old child with possible shock. In pediatric patients, especially young children, blood pressure may not decrease until significant shock has already occurred, making it a late indicator of inadequate perfusion. Depending solely on systolic blood pressure to evaluate perfusion status in this age group can lead to a delay in appropriate interventions. Distal capillary refill time, skin color, and temperature changes, and the presence of peripheral pulses are more sensitive and early indicators of perfusion status in pediatric patients. Monitoring distal capillary refill provides information on peripheral perfusion, while changes in skin color and temperature can signal circulatory compromise. Evaluating the presence or absence of peripheral pulses offers insights into vascular perfusion. These parameters offer more reliable and prompt feedback on a child's perfusion status compared to systolic blood pressure.

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