Nursing Elites

1. The healthcare provider is admitting a child with a Wilms tumor. Which is the initial assessment finding associated with this tumor?

• A. abdominal swelling
• B. weight gain
• C. hypotension
• D. increased urinary output

Correct answer: A

Rationale: Abdominal swelling is a classic presentation and often the first noticeable sign of a Wilms tumor. This occurs due to the tumor mass in the kidney, leading to abdominal distension. Weight gain (Choice B) is less likely as a presenting symptom compared to abdominal swelling. Hypotension (Choice C) is not typically associated with a Wilms tumor unless complications like bleeding or shock occur. Increased urinary output (Choice D) is not a typical finding for Wilms tumor; instead, patients may present with hematuria or urinary symptoms.

2. A child with suspected Kawasaki disease is being assessed. What clinical manifestation is the nurse likely to observe?

• A. Generalized rash
• B. Peeling skin on the hands and feet
• C. High fever
• D. Low-grade fever

Correct answer: B

Rationale: Peeling skin on the hands and feet is a characteristic clinical manifestation of Kawasaki disease, known as desquamation. This occurs during the convalescent phase of the illness, typically around 2-3 weeks after the onset of symptoms. While a generalized rash can be present in Kawasaki disease, peeling skin on the hands and feet is a more specific and distinctive feature. High fever is also a common symptom of Kawasaki disease, usually lasting for at least 5 days, while a low-grade fever is not typically associated with this condition. Therefore, the nurse is more likely to observe peeling skin on the hands and feet in a child suspected of having Kawasaki disease, making option B the correct choice.

3. A nurse is planning an initial home care visit to a mother who gave birth to a high-risk infant. For what time of day should the nurse schedule the visit for it to be most productive?

• A. When the husband is out of the home.
• B. At a time when the mother is feeding the infant.
• C. At a time that is convenient for the family.
• D. When the nurse can spend time with the family.

Correct answer: C

Rationale: Scheduling the visit at a time that is convenient for the family is the most appropriate choice. This ensures that the family is receptive and available, making the visit more productive. Choice A is incorrect because the presence of the husband may be important for support and decision-making. Choice B focuses solely on the mother and the infant's feeding time, which may not align with the family's overall availability. Choice D is incorrect as it emphasizes the nurse's convenience rather than the family's, which may not lead to an effective visit.

4. One principle to be followed for children with type 1 diabetes is to provide for the variability of the child’s activity. What should the nurse teach the child about how to compensate for increased physical activity?

• A. Eat more food when planning to exercise more than usual.
• B. Take oral, not injectable insulin, on days of heavy exercise.
• C. Take insulin in the morning when extra exercise is anticipated.
• D. Eat foods that contain sugar to compensate for the extra exercise.

Correct answer: A

Rationale: The correct answer is to eat more food when planning to exercise more than usual. Increased physical activity requires more energy, so additional food intake is necessary to compensate for the increased energy expenditure. This helps maintain blood sugar levels within the target range. Choice B is incorrect because the mode of insulin administration does not change based on physical activity; the type and dose of insulin remain the same unless adjusted by a healthcare provider. Choice C is incorrect because insulin timing should not be adjusted solely based on anticipated exercise; consistent timing of insulin doses is crucial for stable blood sugar control. Choice D is incorrect because consuming foods with sugar may lead to unstable blood sugar levels and is not the recommended way to compensate for extra exercise, as it can result in sudden spikes and drops in blood glucose levels, affecting overall diabetes management.

5. A healthcare provider is assessing a child with suspected bacterial meningitis. What clinical manifestation is the healthcare provider likely to observe?

• A. Photophobia
• B. High fever
• C. Rash
• D. Nasal congestion

Correct answer: B

Rationale: High fever is a key clinical manifestation of bacterial meningitis due to the inflammatory response in the meninges. Photophobia, choice A, is also commonly observed due to meningeal irritation, but it is not as specific as high fever. Rash, choice C, is more indicative of conditions like meningococcal meningitis rather than bacterial meningitis. Nasal congestion, choice D, is not typically associated with bacterial meningitis. Therefore, the correct answer is B.

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