Nursing Elites

1. When assessing a child with a possible fracture, what would be the most reliable indicator for the nurse to identify?

• A. Lack of spontaneous movement
• B. Point tenderness
• C. Bruising
• D. Inability to bear weight

Correct answer: B

Rationale: Point tenderness is the most reliable indicator of a possible fracture in a child. It refers to localized pain at a specific point, indicating a potential bone injury. Lack of spontaneous movement (Choice A) is non-specific and can be due to various reasons. Bruising (Choice C) may be present in fractures but is not as specific as point tenderness. Inability to bear weight (Choice D) can also be seen in fractures but may not always be present, making it less reliable compared to point tenderness.

2. A nurse is assessing a 10-month-old infant. What developmental milestone should the nurse expect to observe?

• A. Crawling
• B. Sitting without support
• C. Standing with assistance
• D. Pulling to a stand

Correct answer: D

Rationale: The correct answer is D: Pulling to a stand. By 10 months of age, most infants should be able to pull themselves up to a standing position while holding onto furniture or other support. This milestone indicates good strength and coordination in the lower body. Choice A, Crawling, is typically achieved around 6-9 months of age. Choice B, Sitting without support, usually occurs around 6-8 months. Choice C, Standing with assistance, can typically be seen around 9-12 months, but pulling to a stand is a more advanced milestone expected by 10 months.

3. A child with juvenile idiopathic arthritis (JIA) is under the care of a nurse. What is the priority nursing intervention?

• A. Encouraging a diet high in protein
• B. Administering nonsteroidal anti-inflammatory drugs (NSAIDs)
• C. Applying heat to affected joints
• D. Providing range-of-motion exercises

Correct answer: B

Rationale: The priority nursing intervention for a child with juvenile idiopathic arthritis (JIA) is administering nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation. NSAIDs are commonly used in the treatment of JIA to help alleviate symptoms. While encouraging a diet high in protein, applying heat to affected joints, and providing range-of-motion exercises are essential components of care, addressing pain and inflammation with NSAIDs is the priority intervention. This is because controlling pain and inflammation is crucial in improving the child's comfort and quality of life, which takes precedence over other supportive measures.

4. A child is being assessed for suspected intussusception. What clinical manifestation is the healthcare provider likely to observe?

• A. Projectile vomiting
• B. Currant jelly stools
• C. Abdominal distension
• D. Constipation

Correct answer: C

Rationale: The correct clinical manifestation the healthcare provider is likely to observe in a child with suspected intussusception is abdominal distension. Intussusception involves one portion of the intestine telescoping into another, causing obstruction. Abdominal distension is a common symptom due to the obstruction and buildup of gas and fluid in the affected area. While projectile vomiting can occur, it is not as specific to intussusception as abdominal distension. Currant jelly stools, which are stools containing blood and mucus, are a classic sign of intussusception but are not a clinical manifestation observable on assessment. Constipation is not typically associated with intussusception, as this condition often presents with symptoms of bowel obstruction rather than constipation.

5. The nurse is reviewing the laboratory test results of a child diagnosed with disseminated intravascular coagulation (DIC). What would the nurse interpret as indicative of this disorder?

• A. Shortened prothrombin time
• B. Increased fibrinogen level
• C. Positive fibrin split products
• D. Increased platelets

Correct answer: C

Rationale: Positive fibrin split products indicate disseminated intravascular coagulation (DIC), a condition characterized by the widespread formation of blood clots throughout the body. In DIC, clotting factors are consumed, leading to increased fibrin split products. A shortened prothrombin time (Choice A) is not typically seen in DIC as it indicates faster blood clotting, which is not consistent with the pathophysiology of DIC. An increased fibrinogen level (Choice B) is also not a characteristic finding in DIC, as fibrinogen levels may be decreased due to consumption in the formation of clots. Increased platelets (Choice D) are not typically observed in DIC; instead, thrombocytopenia (decreased platelet count) is more common due to their consumption in clot formation.

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