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 brings a 2-month-old infant with Down syndrome to the pediatric clinic for a physical and administration of immunizations. Which clinical finding should alert the nurse to perform a further assessment?

• A. Flat occiput
• B. Small, low-set ears
• C. Circumoral cyanosis
• D. Protruding furrowed tongue

Correct answer: C

Rationale: Circumoral cyanosis should alert the nurse to perform a further assessment because it may indicate inadequate oxygenation or circulation, potentially related to cardiac or respiratory issues. Flat occiput (choice A) is a common finding in infants and is not typically concerning. Small, low-set ears (choice B) are common in Down syndrome and not specifically indicative of an acute issue requiring immediate further assessment. Protruding furrowed tongue (choice D) is also commonly seen in infants with Down syndrome and typically does not warrant immediate further assessment unless associated with other concerning signs or symptoms.

3. A 2-year-old child is admitted to the hospital with a diagnosis of Kawasaki disease. What is the primary goal of therapy during the acute phase?

• A. Preventing coronary artery aneurysms
• B. Reducing fever
• C. Improving cardiac function
• D. Preventing dehydration

Correct answer: A

Rationale: The primary goal of therapy during the acute phase of Kawasaki disease is to prevent coronary artery aneurysms. Kawasaki disease is characterized by systemic vasculitis and the most serious complication is the development of coronary artery aneurysms. While reducing fever and improving cardiac function are important aspects of managing Kawasaki disease, the primary focus in the acute phase is to prevent the development of coronary artery aneurysms. Preventing dehydration is also essential but not the primary goal in managing Kawasaki disease.

4. A healthcare provider is discussing the care of an infant with colic with the parents. What should the healthcare provider explain is the cause of colicky behavior?

• A. Inadequate peristalsis
• B. Paroxysmal abdominal pain
• C. An allergic response to certain proteins in milk
• D. A protective mechanism designed to eliminate foreign proteins

Correct answer: B

Rationale: Colicky behavior in infants is primarily characterized by paroxysmal abdominal pain, resulting in excessive crying and fussiness. The pain episodes are often unpredictable and can be distressing for both the infant and the parents. Inadequate peristalsis (Choice A) refers to weak or ineffective bowel movements and is not the typical cause of colic. While some infants may experience colic due to an allergic response to certain proteins in milk (Choice C), this is not the primary cause of colic behavior in all infants. Choice D, a protective mechanism designed to eliminate foreign proteins, is not a recognized cause of colic. Therefore, the correct explanation for the cause of colicky behavior in infants is paroxysmal abdominal pain.

5. The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. What symptom would the nurse correlate with the disorder?

• A. The parents report that their child had a recent 'cold or flu.'
• B. Blood pressure is decreased during vital signs assessment.
• C. The parents report that their son 'can’t drink enough water.'
• D. Auscultation reveals Kussmaul breathing.

Correct answer: C

Rationale: The correct answer is C. In type 2 diabetes mellitus, excessive thirst (polydipsia) is a common symptom due to high blood glucose levels. This results in the patient feeling unable to drink enough water to satisfy their thirst. The other options are incorrect because a recent 'cold or flu' (choice A) is not directly related to diabetes mellitus, decreased blood pressure (choice B) is not a typical finding in uncontrolled diabetes, and Kussmaul breathing (choice D) is associated with diabetic ketoacidosis, which is more common in type 1 diabetes mellitus.

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