Nursing Elites

1. The nurse is caring for a 10-year-old with Duchenne muscular dystrophy. As part of the plan of care, the nurse focuses on maintaining his cardiopulmonary function. Which intervention would the nurse implement to best promote maximum chest expansion?

• A. Deep-breathing exercises
• B. Upright positioning
• C. Coughing
• D. Chest percussion

Correct answer: B

Rationale: Upright positioning is the optimal intervention to promote maximum chest expansion in a child with Duchenne muscular dystrophy. By placing the child in an upright position, gravity can assist in expanding the chest cavity, facilitating better lung expansion and improving breathing efficiency. Deep-breathing exercises may be beneficial but are not as effective in maximizing chest expansion as upright positioning. Coughing and chest percussion focus more on airway clearance and are not directly aimed at promoting chest expansion.

2. A parent tells the nurse, “My 9-month-old baby no longer has the same strong grasp that was present at birth and no longer acts startled by loud noises.” How should the nurse explain these changes in behavior?

• A. “I will check these responses before deciding how to proceed.”
• B. “Failure of these responses may be related to a developmental delay.”
• C. “Additional sensory stimulation is needed to aid in the return of these responses.”
• D. “These responses are replaced by voluntary activity at about five months of age.”

Correct answer: D

Rationale: The correct answer is D: “These responses are replaced by voluntary activity at about five months of age.” The grasp reflex and startle reflex (Moro reflex) are normal in newborns but typically disappear as the infant's nervous system matures and voluntary control develops. Choice A is incorrect because checking the responses before deciding a course of action does not address the developmental milestone related to the reflexes. Choice B is incorrect as it jumps to a conclusion of developmental delay without considering the normal developmental process. Choice C is incorrect as additional sensory stimulation is not necessary for the return of these reflexes, as they are expected to naturally diminish as part of normal development.

3. A healthcare professional is assessing a child with suspected bacterial meningitis. What is a common clinical manifestation that the healthcare professional is likely to observe?

• A. Rash
• B. Photophobia
• C. Jaundice
• D. Kernig sign

Correct answer: D

Rationale: A common clinical manifestation of bacterial meningitis is a positive Kernig sign, indicating irritation of the meninges. Rash (Choice A) is not typically associated with bacterial meningitis. Photophobia (Choice B) can be present but is more commonly seen in viral meningitis. Jaundice (Choice C) is not a typical clinical manifestation of meningitis and is more indicative of liver dysfunction.

4. A 3-year-old child with a diagnosis of acute otitis media is being discharged. What should the nurse include in the discharge teaching?

• A. Encourage the child to drink plenty of fluids
• B. Encourage the child to eat a balanced diet
• C. Administer pain medication as needed
• D. Apply warm compresses to the affected ear

Correct answer: A

Rationale: The correct answer is to encourage the child to drink plenty of fluids. Encouraging adequate fluid intake helps to relieve symptoms and prevent dehydration in children with acute otitis media. A balanced diet (choice B) is important for overall health but is not specifically related to managing otitis media. While pain medication (choice C) may be prescribed, it should not be administered without medical advice. Applying warm compresses (choice D) is not typically recommended for acute otitis media as it can potentially worsen the condition by promoting bacterial growth.

5. An infant who had cardiac surgery for a congenital defect is to be discharged. What should the nurse emphasize to the parents regarding administering the prescribed antibiotic?

• A. Give the antibiotic between feedings.
• B. Ensure that the antibiotic is administered as prescribed.
• C. Shake the bottle thoroughly before giving the antibiotic.
• D. Keep the antibiotic in the refrigerator after the bottle has been opened.

Correct answer: B

Rationale: The correct answer is B: 'Ensure that the antibiotic is administered as prescribed.' It is crucial for the parents to follow the prescribed antibiotic regimen to prevent infections and promote proper healing following cardiac surgery. Option A is incorrect because the timing of antibiotic administration may vary depending on the specific medication and instructions. Option C is not necessary and could potentially affect the antibiotic's effectiveness. Option D is not relevant to the administration of the antibiotic and does not ensure proper usage.

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