Nursing Elites

1. Parents of a child who will need hemodialysis ask the nurse, What are the advantages of a fistula over a graft or external access device for hemodialysis? (Select all that apply.)

• A. It is ready to be used immediately.
• B. All below
• C. There is less restriction of activity with a fistula.
• D. It produces dilation and thickening of the superficial vessels.

Correct answer: A

Rationale: A fistula typically has fewer complications, allows for greater freedom of movement, and involves natural vessel changes that improve dialysis efficiency. However, it is not ready for immediate use, which is why it may take weeks to mature before it can be used.

2. A child is admitted to the hospital with acute renal failure. The parents ask about the prognosis for acute renal failure. The nurse’s response should be based on which statement about acute renal failure?

• A. Children with acute renal failure will have to take prophylactic antibiotics for life.
• B. Acute renal failure always leads to chronic renal failure.
• C. Acute renal failure may be reversible.
• D. All children with acute renal failure will eventually need a kidney transplant.

Correct answer: C

Rationale: The correct answer is C: Acute renal failure in children is often reversible, especially when the underlying cause is identified and treated promptly. It does not always lead to chronic renal failure or the need for a kidney transplant. Choice A is incorrect as prophylactic antibiotics for life are not a standard treatment for acute renal failure. Choice B is incorrect as acute renal failure does not always progress to chronic renal failure. Choice D is incorrect as not all children with acute renal failure will eventually require a kidney transplant.

3. Why is it difficult to assess a child’s dietary intake?

• A. No systematic assessment tool has been developed
• B. Biochemical analysis for assessing nutrition is expensive
• C. Families usually do not understand much about nutrition
• D. Recall of food consumption is frequently unreliable

Correct answer: D

Rationale: The correct answer is D. Recall of food intake, especially amounts eaten, is often unreliable. While systematic tools like the 24-hour recall and dietary history questionnaires exist, recall can still be challenging in accurately assessing a child's dietary intake. Choices A, B, and C are incorrect because systematic assessment tools do exist, biochemical analysis is not the primary method for dietary assessment, and families' understanding of nutrition may vary but is not the main reason for the difficulty in assessing a child's dietary intake.

4. The nurse is teaching the mother of a 9-month-old infant about administering liquid iron preparation. Which information should be included in the teaching?

• A. Adequate dosage will turn the stools a tarry, black color.
• B. Give Vitamin D to enhance absorption.
• C. Allow the liquid iron to mix with saliva before swallowing.
• D. Give the liquid iron with meals.

Correct answer: A

Rationale: The correct answer is A. Iron supplements can cause stools to turn black, which is a normal and harmless side effect. Iron is best absorbed on an empty stomach, although it can be given with food if gastrointestinal upset occurs. Vitamin C, not D, enhances iron absorption. Choice B is incorrect because Vitamin C enhances iron absorption, not Vitamin D. Choice C is incorrect as there is no need to mix liquid iron with saliva before swallowing. Choice D is incorrect because iron is best absorbed on an empty stomach.

5. You are developing a plan of care for a hospitalized child. Which age group is most likely to view illness as a punishment for misdeeds?

• A. Adolescence
• B. Preschool age
• C. Infancy
• D. School age

Correct answer: B

Rationale: Preschool-aged children often engage in magical thinking, where they may believe that illness is a punishment for misdeeds. This belief is related to their cognitive development stage, where they may attribute cause and effect in a magical or unrealistic way. Adolescents are more likely to view illness as a disruption to their sense of independence or control. Infants lack the cognitive development to associate illness with punishment for misdeeds. School-aged children typically have a more concrete understanding of illness and its causes, moving away from magical thinking.

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