Nursing Elites

1. Marge is a 2-year-old girl who does not sit and eat at mealtimes but rather brings food to many rooms, eats a few bites, and drops it. Her parents report that she is a 'fussy eater.' Marge is significantly below weight for her age. She does not have any oral motor structure abnormalities, but eats only certain foods with the same texture. Which intervention strategy would be best to address the environmental context?

• A. Prolong mealtimes and eliminate all snacks
• B. Provide high-calorie snacks and meals at the table throughout the day
• C. Allow Marge to eat whenever and wherever she wants in the house
• D. Require Marge to eat everything on her plate and at snack

Correct answer: B

Rationale: In the case of Marge, who exhibits selective eating habits and struggles with weight gain, providing high-calorie snacks and meals at the table throughout the day can be an effective intervention. This strategy can help increase her food intake in a structured environment, promoting healthier eating habits and potentially addressing her below-average weight status. Choice A, prolonging mealtimes and eliminating all snacks, may not be the best approach as it could lead to more food refusal and stress during meals. Choice C, allowing Marge to eat whenever and wherever she wants in the house, may further enable her selective eating behavior and hinder progress. Choice D, requiring Marge to eat everything on her plate and at snack, can create a negative mealtime environment and may not address the underlying causes of her eating habits. Therefore, providing high-calorie snacks and meals at designated times offers a balanced approach to support Marge's nutritional needs and overall well-being.

2. For a 6-year-old child with hypokalemia, which menu choice should the nurse encourage?

• A. Pizza with a fruit plate
• B. Chicken strips with chips
• C. Fajita with rice
• D. Hamburger with French fries

Correct answer: A

Rationale: Pizza with a fruit plate is the most suitable choice for a 6-year-old child with hypokalemia due to its potassium content. Potassium-rich foods like fruits can help replenish potassium levels in the body, aiding in the treatment of hypokalemia.

3. Which parental statement at the end of a teaching session by the nurse indicates correct understanding of colostomy stoma care for the infant client?

• A. We will change the colostomy bag with each wet diaper.
• B. We will expect a moderate amount of bleeding after cleansing the area around the stoma.
• C. We will watch for skin irritation around the stoma.
• D. We will use adhesive enhancers when we change the bag.

Correct answer: C

Rationale: Choosing option C, 'We will watch for skin irritation around the stoma,' demonstrates understanding of proper colostomy stoma care. Monitoring for skin irritation is crucial as it can indicate issues such as leakage, improper sealing, or infection. Options A, B, and D are incorrect. Changing the colostomy bag with each wet diaper (option A) is unnecessary unless indicated by a healthcare provider to prevent skin breakdown. Expecting bleeding after cleansing (option B) is not normal and may signal a problem that requires medical attention. Using adhesive enhancers (option D) should be done based on specific recommendations and not necessarily with every bag change.

4. Why should a healthcare professional take time to get to know the things a family does together, their weekly routine, and an explanation of family dynamics?

• A. Involvement in the family is central to best practice
• B. It is not necessary, but it is beneficial
• C. To gather demographic information for documentation purposes
• D. To assess if they have values that align with the practitioner's

Correct answer: A

Rationale: Understanding the activities, routines, and dynamics of a family is crucial for a healthcare professional to provide holistic care. By gaining insight into the family's lifestyle and relationships, the professional can tailor interventions that are better integrated into the family's daily life, fostering more effective therapy outcomes and enhancing the overall quality of care provided. Choice A is the correct answer because involvement in the family is indeed central to best practice in healthcare. Choices B, C, and D are incorrect because simply gathering demographic information, assessing values alignment, or considering it as optional fails to recognize the importance of understanding the family dynamics for effective care delivery.

5. During a vaso-occlusive crisis in sickle cell anemia, what action is crucial for a nurse to take?

• A. Administer meperidine for pain.
• B. Apply cold compresses to the child's joints.
• C. Limit the child's fluid intake.
• D. Maintain bed rest for the child.

Correct answer: D

Rationale: During a vaso-occlusive crisis in sickle cell anemia, maintaining bed rest is crucial to reduce oxygen consumption and alleviate pain. Movement can worsen the crisis by increasing sickling of red blood cells, leading to further tissue damage and pain. Bed rest helps to improve blood flow, reduce pain, and promote healing. Administering meperidine for pain (Choice A) is not recommended due to the risk of normeperidine accumulation and potential neurotoxicity. Applying cold compresses (Choice B) may cause vasoconstriction, worsening the vaso-occlusive crisis. Limiting fluid intake (Choice C) is not appropriate as adequate hydration is essential to prevent dehydration and maintain blood flow.

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