Nursing Elites

1. A 6-year-old with muscular dystrophy was recently injured falling out of bed at home. What intervention should the nurse suggest to prevent further injury?

• A. Recommend raising the bed's side rails when a caregiver is not present.
• B. Suggest a caregiver be present continuously to prevent falls from bed.
• C. Encourage the use of loose restraints while in bed.
• D. Recommend raising the bed's side rails throughout the day and night.

Correct answer: A

Rationale: In this scenario, the most appropriate intervention to prevent further injury is to raise the bed's side rails when a caregiver is not present. This measure helps in preventing falls without the need for constant supervision. Choice B is not practical as continuous caregiver presence may not always be feasible. Choice C is unsafe as loose restraints can pose a strangulation risk. Choice D does not address the need for intervention when a caregiver is absent, potentially leading to an increased risk of falls.

2. What behavior does the nurse anticipate while feeding a newborn with choanal atresia?

• A. Chokes on the feeding
• B. Has difficulty swallowing
• C. Does not appear to be hungry
• D. Takes about half of the feeding

Correct answer: D

Rationale: Correct answer: When feeding a newborn with choanal atresia, the nurse should anticipate that the infant may take only part of the feeding. This behavior is due to the condition causing difficulty in breathing through the nose while feeding, prompting the infant to pause for air. Choice A, 'Chokes on the feeding,' is incorrect as it does not specifically relate to the feeding behavior expected in choanal atresia. Choice B, 'Has difficulty swallowing,' is also incorrect because the issue in choanal atresia is primarily related to breathing rather than swallowing. Choice C, 'Does not appear to be hungry,' is not the typical behavior seen in infants with choanal atresia; they may still display hunger cues but struggle with feeding due to the condition.

3. The nurse is assessing a 3-year-old boy whose parents brought him to the clinic when they noticed that the right side of his abdomen was swollen. What finding would suggest this child has a neuroblastoma?

• A. The child has a maculopapular rash on his palms.
• B. The parents report that their son is vomiting and not eating well.
• C. The parents report that their son is irritable and not gaining weight.
• D. Auscultation reveals wheezing with diminished lung sounds.

Correct answer: B

Rationale: Vomiting and poor appetite can be symptoms of neuroblastoma, a malignancy that affects the adrenal glands and sympathetic nervous system. A maculopapular rash on the palms (Choice A) is not typically associated with neuroblastoma. Irritability and poor weight gain (Choice C) may be non-specific findings and do not specifically point towards neuroblastoma. Auscultation findings of wheezing with diminished lung sounds (Choice D) are more indicative of respiratory conditions rather than neuroblastoma.

4. A nurse is teaching the parents of a child with a diagnosis of epilepsy about seizure precautions. What should the nurse include in the teaching?

• A. Keep a diary of seizure activity
• B. Administer antiepileptic medication only when a seizure occurs
• C. Restrict the child's activities to prevent seizures
• D. Teach seizure first aid to family members

Correct answer: D

Rationale: Teaching seizure first aid to family members is essential as it empowers them to respond effectively during a seizure. Keeping a diary of seizure activity is important for tracking patterns and triggers but is not directly related to immediate safety. Administering antiepileptic medication only when a seizure occurs is not recommended as medications should be administered as prescribed by healthcare providers. Restricting the child's activities to prevent seizures is not appropriate as children with epilepsy should be encouraged to lead active lives while taking necessary precautions.

5. A 15-month-old child with the diagnosis of hydrocephalus is scheduled for a computed tomography (CT) scan. What should the nurse include when preparing the toddler for the CT scan?

• A. Shaving the head
• B. Starting the prescribed IV infusion
• C. Administering the prescribed sedative
• D. Giving the child a simple explanation of the procedure

Correct answer: D

Rationale: Preparing a toddler for a CT scan involves providing a simple explanation of the procedure to reduce anxiety and help the child understand what will happen. This approach helps establish trust and cooperation, making the experience less frightening for the child. Shaving the head, starting an IV infusion, or administering a sedative are not typically part of the preparation for a CT scan in a toddler and may not be necessary or appropriate in this scenario.

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