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. A child has Wilms' tumor and is scheduled for surgery. Which of the following actions should the nurse include in the plan of care?

• A. Palpate the child's abdomen daily for tumor size.
• B. Reposition the child frequently.
• C. Prepare the child for chemotherapy.
• D. Avoid palpating the abdomen.

Correct answer: D

Rationale: Palpating the abdomen of a child with Wilms' tumor should be avoided to prevent the risk of rupturing the tumor and spreading cancer cells. This action is crucial to maintain the child's safety and prevent potential complications before surgery.

3. A nurse is caring for a school-age child with primary nephrotic syndrome who is taking prednisone. After 1 week of treatment, which manifestation indicates to the nurse that the medication is effective?

• A. Decreased edema
• B. Increased abdominal girth
• C. Decreased appetite
• D. Increased protein in the urine

Correct answer: A

Rationale: In a child with nephrotic syndrome, the presence of edema is due to fluid retention caused by protein loss in the urine. Prednisone, a corticosteroid, helps reduce inflammation and decrease the loss of protein in the urine, leading to a decrease in edema. Therefore, decreased edema is an indication that the prednisone treatment is effective in managing the nephrotic syndrome. Increased abdominal girth would indicate fluid retention and worsening of the condition. Decreased appetite is a nonspecific symptom and not a direct indicator of prednisone efficacy. Increased protein in the urine would indicate ongoing renal impairment and the ineffectiveness of the treatment.

4. The nurse is teaching a patient with cancer about a new prescription for a fentanyl patch, 25mcg/hr. for chronic back pain. Which statement is the most appropriate to include in the teaching plan.

• A. You will need to change this patch every day, regardless of your pain level.
• B. This type of pain medication is not as likely to cause breathing problems.
• C. With the first patch, it will take about 24hrs before you feel the full effects.
• D. Use your heating pad for the back pain. It will also improve the patch�s effectiveness.

Correct answer: C

Rationale: Full analgesic effects can take up to 24 hours to develop with fentanyl patches. Most patches are changed every 72 hours. Has the same adverse effects as other opioids, including respiratory depression. Should avoid exposing the patch to external heat sources, because this may increase toxicity.

5. Which of the following statements best describes the benefit of using an occupation-centered practice model?

• A. Addresses the unique value of occupation
• B. Provides intervention protocols
• C. Provides specific intervention activities
• D. Addresses children's limitations in skills

Correct answer: A

Rationale: An occupation-centered practice model focuses on the unique value of engaging in meaningful and purposeful activities, known as occupations. By addressing the significance of occupation in an individual's life, this model emphasizes the importance of activities that hold personal meaning and relevance. Understanding and incorporating the value of occupation can lead to more client-centered and holistic interventions that promote health and well-being. Choice B is incorrect as the model emphasizes the value of occupations, not just intervention protocols. Choice C is incorrect as the model is centered around the value of occupations, not just specific intervention activities. Choice D is incorrect as the model is not primarily focused on addressing children's limitations in skills, but rather on the significance of engaging in meaningful activities.

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