Nursing Elites

1. The parents of a 5-year-old child, recently diagnosed with celiac disease, are being educated by the healthcare provider. Which statement by the parents indicates a need for further teaching?

• A. We need to avoid giving our child any foods that contain wheat, barley, or rye
• B. Our child can still eat oats as long as they are labeled gluten-free
• C. We should read food labels carefully to check for hidden sources of gluten
• D. It’s okay for our child to have small amounts of gluten occasionally

Correct answer: D

Rationale: The correct answer is D. Children with celiac disease must strictly adhere to a gluten-free diet. Even small amounts of gluten can cause harm by triggering an immune response that damages the intestines. It is crucial for parents to understand that allowing their child to have small amounts of gluten occasionally is not safe and can lead to complications. Therefore, further teaching is needed to emphasize the importance of complete avoidance of gluten-containing foods for a child with celiac disease. Choices A, B, and C demonstrate understanding of the need to avoid gluten-containing foods and hidden sources of gluten, which are essential in managing celiac disease. Choice D is incorrect as it suggests a lax approach to the child's diet, which can be harmful in the case of celiac disease.

2. A 15-month-old child is brought to the clinic for a routine checkup. The nurse notes that the child is not walking independently yet. What should the nurse do next?

• A. Refer the child for a developmental assessment
• B. Encourage the parents to start physical therapy
• C. Reassure the parents that some children walk later than others
• D. Discuss the importance of early intervention services

Correct answer: C

Rationale: The correct answer is to reassure the parents that some children walk later than others. It is essential to understand that children reach developmental milestones at different ages. Walking independently can occur later in some children, and it is normal. Referring the child for a developmental assessment (Choice A) may cause unnecessary concern at this stage. Encouraging physical therapy (Choice B) or discussing early intervention services (Choice D) may not be warranted unless there are specific concerns identified during the checkup.

3. The nurse is measuring the frontal occipital circumference (FOC) of a 3-month-old infant and notes that the FOC has increased by 5 inches since birth, and the child's head appears large in relation to body size. Which action is most important for the nurse to take next?

• A. Measure the infant's head-to-toe length.
• B. Palpate the anterior fontanel for tension and bulging.
• C. Observe the infant for sunken eyes.
• D. Plot the measurement on the infant's growth chart.

Correct answer: B

Rationale: Palpating the anterior fontanel for tension and bulging is crucial in assessing for increased intracranial pressure. In this scenario, the infant's large head size and rapid increase in the frontal occipital circumference raise concerns for potential issues such as hydrocephalus. Measuring the head-to-toe length (Choice A) is not the priority when assessing for increased intracranial pressure. Observing for sunken eyes (Choice C) is more indicative of dehydration rather than increased intracranial pressure. While plotting the measurement on the infant's growth chart (Choice D) is important for tracking growth, it does not address the immediate concern of assessing for increased intracranial pressure.

4. The nurse provides information about the human papillomavirus (HPV) vaccine to the mother of a 14-year-old adolescent who came to the clinic this morning complaining of menstrual cramping. Which explanation should the nurse provide to support administering the HPV vaccine to the adolescent at this visit?

• A. Use of protective barriers during sexual activity prevents most strains of HPV infection
• B. Most adolescents are not honest about being sexually active
• C. Not all strains of HPV will be covered if given at a later date
• D. Immunity must be established to prevent future HPV infection and the risk for cervical cancer

Correct answer: D

Rationale: Administering the HPV vaccine at this visit is essential to establish immunity against HPV, thus reducing the risk of HPV infection and cervical cancer. Vaccination is a proactive measure to protect the adolescent's health in the future. Choice A is incorrect because although protective barriers can reduce the risk of HPV transmission, the vaccine provides broader protection. Choice B is incorrect as it makes a generalization about adolescent behavior that is not relevant to vaccination. Choice C is incorrect as it suggests that delaying vaccination would not impact coverage, which is inaccurate as earlier vaccination provides broader protection against HPV strains.

5. In a 6-year-old child with asthma experiencing difficulty breathing and using accessory muscles to breathe with a peak flow reading in the red zone, what should the nurse do first?

• A. Administer a nebulized bronchodilator
• B. Obtain an arterial blood gas
• C. Start the child on oxygen therapy
• D. Contact the healthcare provider

Correct answer: A

Rationale: The correct action for a 6-year-old child with asthma who is experiencing difficulty breathing, using accessory muscles to breathe, and has a peak flow reading in the red zone is to administer a nebulized bronchodilator first. Nebulized bronchodilators work rapidly to open up the airways, providing immediate relief and improving breathing. This intervention is crucial in addressing the acute respiratory distress the child is facing. Obtaining an arterial blood gas, starting oxygen therapy, or contacting the healthcare provider can be considered after the initial administration of the bronchodilator, as they are not the primary interventions needed to manage the child's acute respiratory distress.

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