Nursing Elites

1. In counseling the parents of a child with hypopituitarism, Nurse Gyimah is asked about their child's condition. Which of the following phrases, if stated by the nurse, best describes the condition?

• A. Linear growth retardation with skeletal proportions normal for chronologic age
• B. A complete normal growth pattern, but with the onset of precocious puberty
• C. Normal growth for the first five years, followed by progressive linear growth retardation
• D. Growth retardation in which height and weight are equally affected

Correct answer: A

Rationale: Hypopituitarism is characterized by linear growth retardation with skeletal proportions normal for chronologic age. This means that although the child experiences growth retardation, their skeletal proportions are appropriate for their age, which distinguishes it from other conditions like precocious puberty or equal height and weight affectation. Choice B is incorrect as hypopituitarism does not involve precocious puberty. Choice C is wrong as it describes a different growth pattern not typical of hypopituitarism. Choice D is also incorrect as in hypopituitarism, height and weight are not equally affected, rather the focus is on linear growth retardation with normal skeletal proportions.

2. Physical abuse of a 4-year-old child should be suspected if you observe:

• A. purple and yellow bruises on the thighs.
• B. bruises on the anterior tibial area.
• C. the child clinging to his or her parent.
• D. curious siblings watching you.

Correct answer: A

Rationale: Purple and yellow bruises on protected areas like the thighs are concerning as they indicate bruises in various stages of healing, which is a red flag for physical abuse. Bruises on the anterior tibial area or a child clinging to a parent are not specific signs of physical abuse. Siblings watching you is unrelated to the suspicion of physical abuse in this scenario.

3. Use this scenario to answer questions 70 to 72. Madam KK brought her two-month-old sick child to your facility. She complains that the child is having a fever, fast breathing, and is not eating anything. Using the IMNCI, what will be the steps to manage this child?

• A. i. Provide practical treatment instructions
• B. ii. Triage based on the severity of illness
• C. iii. Perform a head-to-toe assessment
• D. iv. Identify specific treatments

Correct answer: D

Rationale: To manage the sick child using IMNCI, the correct steps are as follows: Triage based on the severity of illness, Perform a head-to-toe assessment, Identify specific treatments, Provide practical treatment instructions, and Assess feeding while providing counseling. The correct answer, 'D,' focuses on identifying specific treatments, which is crucial in addressing the child's condition effectively. Choice A ('Provide practical treatment instructions') is not the initial step and should come after identifying specific treatments. Choice B ('Triage based on the severity of illness') and Choice C ('Perform a head-to-toe assessment') are essential steps but should follow the identification of specific treatments in the IMNCI approach.

4. Madam Serwaa's 7-month-old baby was admitted to your ward with malnutrition. The child has diarrhea with signs of moderate dehydration but can drink. Which of the following will be the most appropriate fluid for Madam Serwaa's baby?

• A. ORS
• B. Resomal
• C. Rice water
• D. I.V. Ringer's lactate

Correct answer: A

Rationale: For a 7-month-old baby with diarrhea and signs of moderate dehydration who can still drink, the most appropriate fluid is Oral Rehydration Solution (ORS). ORS helps in rehydrating the body and replenishing lost electrolytes, making it essential in managing dehydration due to diarrhea.

5. Upon assessing a newborn immediately after delivery, you note that the infant is breathing spontaneously and has a heart rate of 80 beats/min. What is the MOST appropriate initial management for this newborn?

• A. Assess the newborn's skin condition and color.
• B. Initiate positive-pressure ventilations.
• C. Start chest compressions and contact medical control.
• D. Provide blow-by oxygen with oxygen tubing.

Correct answer: B

Rationale: In a newborn with a heart rate below 100 beats/min, the most appropriate initial management is to initiate positive-pressure ventilations. This helps support the newborn's respiratory effort and oxygenation in the setting of a low heart rate, ensuring adequate oxygen supply to vital organs. Assessing the skin condition and color, starting chest compressions, or providing blow-by oxygen are not the priority in this scenario where respiratory support is crucial.

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