Nursing Elites

1. A child presents to the emergency department with colicky abdominal pain in the lower right quadrant. What disorder is suspected based on these symptoms?

• A. Peritonitis
• B. Appendicitis
• C. Intussusception
• D. Hirschsprung's disease

Correct answer: B

Rationale: The child's presentation of colicky abdominal pain in the lower right quadrant is classic for appendicitis. Appendicitis typically presents with localized pain that starts near the umbilicus and then shifts to the right lower quadrant. Peritonitis, on the other hand, is characterized by diffuse abdominal pain, tenderness, and guarding, usually resulting from organ perforation or intestinal obstruction. Intussusception is associated with acute, severe abdominal pain and currant jelly-like stools due to intestinal telescoping. Hirschsprung's disease, which lacks ganglion cells in the colon, manifests with symptoms like constipation, abdominal distension, and foul-smelling, ribbon-like stools.

2. The nurse is caring for a client in the late stages of Amyotrophic Lateral Sclerosis (A.L.S.). Which finding would the nurse expect?

• A. Confusion
• B. Loss of half of the visual field
• C. Shallow respirations
• D. Tonic-clonic seizures

Correct answer: C

Rationale: In the late stages of Amyotrophic Lateral Sclerosis (A.L.S.), respiratory muscles are affected, leading to shallow respirations. Confusion is not typically associated with A.L.S. Loss of half of the visual field suggests a neurological issue unrelated to A.L.S., while tonic-clonic seizures are not commonly seen in A.L.S. patients. Shallow respirations are a hallmark sign of respiratory muscle weakness in A.L.S. due to the degeneration of motor neurons.

3. A patient experiences a chest wall contusion as a result of being struck in the chest with a baseball bat. The emergency department nurse would be most concerned if which finding is observed during the initial assessment?

• A. Paradoxic chest movement
• B. Complaint of chest wall pain
• C. Heart rate of 110 beats/minute
• D. Large bruised area on the chest

Correct answer: A

Rationale: Paradoxic chest movement is the most concerning finding as it indicates a potential flail chest, which can lead to severe compromise in gas exchange and rapid hypoxemia. This condition requires immediate attention to prevent respiratory distress. Complaint of chest wall pain, a slightly elevated heart rate, and a large bruised area on the chest are important assessment findings but may not immediately threaten gas exchange or respiratory function. Therefore, identifying paradoxic chest movement is critical for prompt intervention and management.

4. A healthcare provider is assessing vital signs in pediatric patients. Which of the following vital signs is abnormal?

• A. 11-year-old male: 90 BPM, 22 RPM, 100/70 mmHg
• B. 13-year-old female: 105 BPM, 22 RPM, 105/50 mmHg
• C. 5-year-old male: 102 BPM, 24 RPM, 90/65 mmHg
• D. 6-year-old female: 100 BPM, 26 RPM, 90/70 mmHg

Correct answer: B

Rationale: The normal range of vital signs for pediatric patients varies with age. For 11 to 14-year-olds, the normal vital sign ranges are: Heart rate: 60-105 BPM; Respiratory rate: 12-20 RPM; Blood pressure: Systolic 85-120 mmHg, Diastolic 55-80 mmHg. The 13-year-old female in choice B has a diastolic blood pressure below the normal range, indicating hypotension. Additionally, her heart rate is at the upper limit of normal, and her respiratory rate is within normal limits. Choices A, C, and D all fall within the normal ranges for vital signs in pediatric patients.

5. A mother brings her 26-month-old to the well-child clinic. She expresses frustration and anger due to her child's constant saying 'no' and refusal to follow her directions. The nurse explains this is normal for his age, as negativism is attempting to meet which developmental need?

• A. Trust
• B. Initiative
• C. Independence
• D. Self-esteem

Correct answer: C

Rationale: In Erikson's theory of development, toddlers struggle to assert independence. They often use the word 'no' even when they mean yes. This stage is called autonomy versus shame and doubt. The child's behavior of saying 'no' and resisting directions reflects the developmental need for independence, not trust (option A), initiative (option B), or self-esteem (option D). Trust is typically associated with early infancy, initiative with preschool age, and self-esteem with later childhood and adolescence.

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