Nursing Elites

1. An infant who has had diarrhea for 3 days is admitted in a lethargic state and is breathing rapidly. The parent states that the baby has been ingesting formula, although not as much as usual, and cannot understand the sudden change. What explanation should the nurse give the parent?

• A. Cellular metabolism is unstable in young children.
• B. The proportion of water in the body is less than in adults.
• C. Renal function is immature in children until they reach school age.
• D. The extracellular fluid requirement per unit of body weight is greater than in adults.

Correct answer: D

Rationale: The correct answer is D. Infants have a higher extracellular fluid requirement per unit of body weight, making them more susceptible to dehydration and electrolyte imbalances during illnesses such as diarrhea. Choice A is incorrect because cellular metabolism being unstable is not the primary explanation for the symptoms described. Choice B is incorrect as the proportion of water in the body alone does not fully explain the increased risk of dehydration in infants. Choice C is incorrect because while renal function is immature in children, it is not the most relevant factor in this scenario compared to the increased fluid requirements.

2. When picked up by a parent or the nurse, an 8-month-old infant screams and seems to be in pain. After observing this behavior, what should the nurse discuss with the parent?

• A. Accidents and the importance of preventing them
• B. Limiting the infant's playtime with other children in the family
• C. Any other behaviors that the parent may have noticed
• D. Nutrition and specific vitamins recommended for infants

Correct answer: C

Rationale: Discussing any other observed behaviors with the parent is important to identify patterns or potential issues that could be affecting the infant's well-being. By exploring additional behaviors, the nurse can gather more information to assess the infant comprehensively. This approach allows for a more holistic understanding of the infant's health status, rather than focusing solely on the observed behavior of screaming and apparent pain. Options A, B, and D are incorrect as they do not directly address the need to explore other behaviors that may provide insights into the infant's condition and well-being.

3. A child with a diagnosis of pyloric stenosis is scheduled for surgery. What preoperative intervention is important for the nurse to perform?

• A. Administering intravenous fluids
• B. Monitoring for signs of infection
• C. Monitoring for signs of dehydration
• D. Monitoring for signs of pain

Correct answer: C

Rationale: The correct preoperative intervention for a child with pyloric stenosis is to monitor for signs of dehydration. Pyloric stenosis involves the obstruction of the pyloric sphincter, leading to projectile vomiting, which can result in dehydration and electrolyte imbalances. Monitoring for signs of dehydration is crucial to assess the child's fluid status and prevent complications. Administering intravenous fluids, although important in managing dehydration, is not typically a preoperative intervention but rather a treatment during or after surgery. Monitoring for signs of infection and pain may also be important but are not the priority preoperative interventions in a child with pyloric stenosis.

4. Which of the following signs or symptoms is more common in children than adults following head trauma?

• A. nausea and vomiting
• B. altered mental status
• C. tachycardia and diaphoresis
• D. changes in pupillary reaction

Correct answer: A

Rationale: Nausea and vomiting are more common in children following head trauma due to their higher risk of increased intracranial pressure. Children have less space for swelling within the skull compared to adults, making them more prone to experiencing symptoms like nausea and vomiting. Altered mental status and changes in pupillary reaction can also occur in both children and adults following head trauma, but they are not specifically more common in children. Tachycardia and diaphoresis are generally signs of autonomic nervous system activation and may occur in both children and adults, but they are not typically more common in children compared to adults following head trauma.

5. A nurse in the emergency department observes large welts and scars on the back of a child who has been admitted for an asthma attack. What additional information must be included in the nurse’s assessment?

• A. History of an injury
• B. Signs of child abuse
• C. Presence of food allergies
• D. Recent recovery from chickenpox

Correct answer: B

Rationale: The correct answer is B: Signs of child abuse. Large welts and scars on a child may be indicative of abuse, making it crucial for the nurse to assess and report any suspicions. Assessing the history of an injury (choice A) may not provide insight into the cause of the welts and scars as effectively as looking for signs of potential abuse. Food allergies (choice C) and recent recovery from chickenpox (choice D) are not directly relevant to the observation of welts and scars on the child's back.

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