Nursing Elites

1. At a well-visit, a mother voices concern that her 30-month-old has a smaller vocabulary than other children in his daycare. The nurse should:

• A. Admit the child to the hospital
• B. Assess the child for other age-appropriate development
• C. Suggest that the child is hearing impaired
• D. Explain that the child has a significant developmental delay

Correct answer: B

Rationale: When a parent expresses concern about a child's development, it is essential to conduct a comprehensive assessment of all areas of development before jumping to conclusions. Choosing option B allows the nurse to evaluate the child for other age-appropriate developmental milestones to determine if there are any delays or concerns. Admitting the child to the hospital (option A) is not necessary at this point and may cause unnecessary stress. Suggesting hearing impairment (option C) without proper evaluation can lead to misdiagnosis. Explaining a significant developmental delay (option D) should only be done after a thorough assessment and diagnosis.

2. Children are taught the values of their culture through observation and feedback relative to their own behavior. In teaching a class on cultural competence, the nurse should be aware that which factor may be culturally determined?

• A. Ethnicity
• B. Racial variation
• C. Status
• D. Geographic boundaries

Correct answer: C

Rationale: Status, or the social standing within a culture, is often culturally determined and plays a significant role in shaping behaviors and expectations.

3. In pediatric patients, what is the primary concern with untreated vesicoureteral reflux (VUR)?

• A. Recurrent UTIs
• B. Chronic renal failure
• C. Hypertension
• D. Bladder dysfunction

Correct answer: B

Rationale: The primary concern with untreated vesicoureteral reflux (VUR) in pediatric patients is chronic renal failure. Untreated VUR can lead to this complication due to recurrent urinary tract infections and kidney damage. While recurrent UTIs (Choice A) are a common consequence of VUR, the ultimate worry is the development of chronic renal failure. Hypertension (Choice C) may occur as a result of renal damage but is not the primary concern. Bladder dysfunction (Choice D) is not the most significant consequence of untreated VUR in terms of long-term outcomes compared to chronic renal failure.

4. Why is knowledge of developmental theories useful for the nurse?

• A. Allows the nurse to know exactly what to do when caring for pediatric patients
• B. Is predictable and aids in controlling the child’s development
• C. Is a set of facts that each child follows in a prescribed method
• D. Provides a framework to guide the nurse in caring for the patient

Correct answer: D

Rationale: The correct answer is D. Understanding developmental theories helps nurses anticipate and plan appropriate care based on the child’s developmental stage. Choice A is incorrect because developmental theories provide a framework but do not dictate exact actions. Choice B is incorrect as developmental processes are not entirely predictable and are not meant to control a child’s development. Choice C is incorrect as developmental theories are not a strict set of facts that all children follow in a prescribed manner, but rather guidelines for understanding and supporting a child's growth and development.

5. A health care provider prescribes feedings of 1 to 2 oz Pedialyte every 3 hours and to advance to 1/2 strength Similac with iron as tolerated postoperatively for an infant who had a pyloromyotomy. The nurse should decide to advance the feeding if which occurs?

• A. The infant's IV line has infiltrated.
• B. The infant has not voided since surgery.
• C. The infant's mother states the infant is tolerating the feeding okay.
• D. The infant is taking the Pedialyte without vomiting or distention.

Correct answer: D

Rationale: The decision to advance feedings after a pyloromyotomy is based on the infant's ability to tolerate the current feedings without vomiting or abdominal distention. Ensuring the infant can keep down Pedialyte is the key indicator for moving to the next stage of feeding. Choices A, B, and C are incorrect because they do not directly relate to the infant's ability to tolerate the feeding. An infiltrated IV line, lack of voiding, or the mother's statement do not provide direct information on the infant's tolerance to the feeding, unlike the absence of vomiting and distention.

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