Nursing Elites

1. How would you classify a child at two years of age who has fast breathing without chest indrawing or stridor when calm?

• A. Very severe disease
• B. Pneumonia
• C. No pneumonia
• D. Local infection

Correct answer: B

Rationale: In pediatric clinical assessment, a child at two years of age with fast breathing but without chest indrawing or stridor when calm is classified as having pneumonia. Fast breathing in this context is a key symptom used in the Integrated Management of Childhood Illness (IMCI) guidelines to diagnose pneumonia in children under five years old. The absence of chest indrawing or stridor when the child is calm helps differentiate this case from other respiratory conditions, making pneumonia the likely classification. Choices A, C, and D are incorrect. 'Very severe disease' is too broad and not specific to the symptoms described. 'No pneumonia' is also incorrect as the symptoms match the presentation of pneumonia. 'Local infection' is too vague and does not specifically address the respiratory symptoms observed.

2. A child newly diagnosed with diabetes mellitus has been stabilized with insulin injections daily. A nurse prepares a discharge teaching plan regarding the insulin. The teaching plan should reinforce which of the following concepts?

• A. Always store insulin vials in the refrigerator
• B. Adjust insulin dosage before exercise
• C. Presence of ketones in urine indicates a need for less insulin
• D. Systematically rotate injection sites

Correct answer: D

Rationale: Systematically rotating injection sites is crucial to prevent tissue damage and ensure optimal insulin absorption. This practice helps in preventing lipohypertrophy, a condition characterized by fat accumulation at injection sites, which can affect insulin absorption and lead to inconsistent blood glucose control. By rotating injection sites, the risk of skin and tissue damage is minimized, and insulin's effectiveness is maintained over time.

3. When educating the parents of a child diagnosed with hypothyroidism, the nurse mentions that the child should avoid goitrogens. Which of the following will the nurse mention as an example?

• A. Orange
• B. Tomatoes
• C. Cabbage
• D. Grapes

Correct answer: C

Rationale: Cabbage is an example of a goitrogen. Goitrogens are substances that interfere with the normal function of the thyroid gland by inhibiting iodine uptake. Cabbage, along with other cruciferous vegetables like broccoli and cauliflower, contain compounds that can have this effect and should be consumed in moderation by individuals with hypothyroidism to prevent worsening of their condition.

4. A 6-year-old male is hospitalized in stable condition with multiple fractures following a car accident. The child's parents tell the nurse that their 7-year-old daughter is very upset about the accident and is concerned that her brother will die. Which suggestion by the nurse is most appropriate?

• A. Encourage the parents to phone the sister frequently with updates on her brother's condition.
• B. Suggest that the sister come to the hospital for a visit.
• C. Suggest that one parent leave the hospital to spend extra time with their daughter at home.
• D. Remind the parents that it is normal for children to be upset when their sibling is hospitalized.

Correct answer: B

Rationale: In situations where a sibling is upset about a family member being hospitalized, suggesting that the sister come to the hospital for a visit can help alleviate her concerns. This allows the sister to see her brother, ask questions, and receive reassurance from seeing him in stable condition. Direct contact and interaction can often provide more comfort and understanding than phone calls or staying at home. Encouraging phone calls (Choice A) might not provide the same level of comfort as a physical visit. While spending extra time with the daughter at home (Choice C) is important, in this scenario, facilitating a visit to the hospital can address the daughter's immediate concerns better. Reminding the parents that it is normal for children to be upset (Choice D) is not as proactive as arranging for the sister to visit her brother.

5. Which of the following statements regarding pediatric anatomy is correct?

• A. The child's trachea is more rigid and less prone to collapse.
• B. The occiput is proportionately larger when compared to an adult.
• C. Airway obstruction is common in children due to their large uvula.
• D. Relative to the overall size of the airway, a child's epiglottis is smaller.

Correct answer: B

Rationale: The occiput, the back part of the head, is proportionately larger in children compared to adults, which can have implications for airway management techniques. This anatomical difference is important to consider when providing care to pediatric patients, especially during airway interventions.

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