Nursing Elites

1. During examination of a toddler's extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is which?

• A. Abnormal and requires further investigation
• B. Abnormal unless it occurs in conjunction with knock-knee
• C. Normal if the condition is unilateral or asymmetric
• D. Normal because the lower back and leg muscles are not yet well developed

Correct answer: D

Rationale: Bowleggedness is normal in toddlers due to the development of lower back and leg muscles. It usually resolves as the child grows.

2. Why are neonates predisposed to problems with thermoregulation?

• A. Renal function is not fully developed.
• B. Flexed posture favors heat loss.
• C. A large body surface area favors heat loss to the environment.
• D. A thick layer of subcutaneous fat provides excellent insulation.

Correct answer: C

Rationale: Neonates have a large surface area relative to their weight, which makes them prone to heat loss to the environment, leading to thermoregulation issues. The underdeveloped kidney affecting urine concentration (Choice A) is unrelated to the thermal regulation process. While a flexed posture can help retain heat (Choice B), it does not outweigh the impact of the large body surface area in neonates. Although subcutaneous fat (Choice D) provides insulation, in neonates, the large body surface area is more significant in contributing to heat loss than the fat's insulating properties.

3. What is the most effective way to prevent the spread of hand, foot, and mouth disease in a daycare setting?

• A. Handwashing
• B. Isolating sick children
• C. Disinfecting toys
• D. Encouraging vaccination

Correct answer: A

Rationale: Handwashing is indeed the most effective way to prevent the spread of hand, foot, and mouth disease in children. Proper hand hygiene helps in removing and killing germs that can cause infections. While isolating sick children and disinfecting toys are important measures to prevent the spread of diseases, they are not as effective as handwashing. Encouraging vaccination, in this case, is not relevant since there is no specific vaccine available for hand, foot, and mouth disease.

4. A toddler’s mother calls the nurse because she thinks her son has swallowed a button type of battery. He has no signs of respiratory distress. The nurse’s response should be based on which premise?

• A. An emergency laparotomy is very likely.
• B. The location needs to be confirmed by radiographic examination.
• C. Surgery will be necessary if the battery has not passed in the stool in 48 hours.
• D. Careful observation is essential because an ingested battery cannot be accurately detected.

Correct answer: B

Rationale: Radiographic examination is essential to confirm the location of the battery, as it can cause significant damage, particularly if lodged in the esophagus. Immediate surgery may be required depending on its location and the potential for causing harm.

5. When should a child receive the first dose of the hepatitis B virus (HBV) vaccine if the mother is hepatitis B surface antigen (HBsAg) negative?

• A. 2 months of age, before hospital discharge.
• B. Birth before discharge from the hospital.
• C. 6 months of age, at the third well-child visit.
• D. No time (this vaccine is not currently recommended).

Correct answer: B

Rationale: If the mother is HBsAg negative, it is recommended that the child receives the first dose of the hepatitis B vaccine at birth before discharge from the hospital. This is to provide early protection against the hepatitis B virus. The second dose of the vaccine is typically given at the first well-child visit, and the third dose is usually administered at a later date. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the Committee on Infectious Diseases of the American Academy of Pediatrics govern the recommendations for immunization, including the hepatitis B virus vaccine. Choice A is incorrect as the first dose should ideally be given at birth. Choice C is incorrect as waiting until 6 months of age may leave the child vulnerable to infection during the early months of life. Choice D is incorrect as the hepatitis B vaccine is recommended for all newborns, especially if the mother is HBsAg negative, to prevent transmission of the virus.

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