Nursing Elites

1. The parents of a 3-year-old boy who has Duchenne muscular dystrophy (DMD) ask, 'how can our son have this disease? We are wondering if we should have any more children.' What information should the nurse provide these parents?

• A. This is an inherited X-linked recessive disorder, which primarily affects male children in the family.
• B. The male infant had a viral infection that went unnoticed and untreated, leading to muscle damage.
• C. The lack of the protein dystrophin in the mother can impact the muscle groups of males.
• D. Damage to the spinal cord due to birth trauma from a breech vaginal birth weakens the muscles.

Correct answer: A

Rationale: The nurse should inform the parents that Duchenne muscular dystrophy is an X-linked recessive disorder, which primarily affects male children in the family. This genetic condition is caused by a mutation in the dystrophin gene located on the X chromosome. Females are usually carriers of the gene mutation and may pass it on to their sons. Daughters of carrier mothers have a 50% chance of being carriers themselves. Understanding the genetics of DMD can help the parents make informed decisions about family planning and genetic counseling.

2. While assessing the vital signs of a 10-year-old who underwent a tonsillectomy this morning, the nurse observes the child swallowing every 2-3 minutes. Which assessment should the nurse implement?

• A. Inspect the posterior oropharynx
• B. Assess for teeth clenching or grinding
• C. Touch the tonsillar pillars to stimulate the gag reflex
• D. Ask the child to speak to evaluate a change in voice tone

Correct answer: A

Rationale: Frequent swallowing post-tonsillectomy may indicate bleeding. Inspecting the posterior oropharynx is essential to assess for any signs of bleeding, such as fresh blood or clots, which may necessitate immediate intervention. Option B is incorrect as teeth clenching or grinding is not directly related to the observation of frequent swallowing in this scenario. Option C is incorrect because stimulating the gag reflex is not necessary at this point and may be uncomfortable for the child. Option D is incorrect as evaluating a change in voice tone is not relevant to the situation of observing frequent swallowing.

3. The healthcare professional working on the pediatric unit takes two 8-year-old girls to the playroom. Which activity is best for the healthcare professional to plan for these girls?

• A. Selecting a board game.
• B. Playing doctor and patient.
• C. Watching cartoons on TV.
• D. Coloring, cutting, and pasting.

Correct answer: A

Rationale: Selecting a board game is the best activity for the healthcare professional to plan for these girls as it is age-appropriate and promotes social interaction. Board games can enhance cognitive skills, encourage teamwork, and provide an enjoyable and interactive experience for the girls.

4. A 7-year-old child is admitted to the hospital with nephrotic syndrome. The nurse notes that the child has gained 3 pounds in the past 24 hours. What should the nurse do first?

• A. Administer a diuretic as prescribed
• B. Restrict the child’s fluid intake
• C. Notify the healthcare provider
• D. Measure the child’s abdominal girth

Correct answer: C

Rationale: In a child with nephrotic syndrome experiencing sudden weight gain, the priority action for the nurse is to notify the healthcare provider. This weight gain could indicate worsening edema or fluid retention, necessitating immediate medical evaluation and intervention. The healthcare provider can conduct a comprehensive assessment, order necessary tests, and adjust the treatment plan accordingly. Administering a diuretic, restricting fluid intake, or measuring abdominal girth should not be initiated without healthcare provider consultation to ensure appropriate management of the child's condition.

5. What is the priority action for a 2-year-old child with croup presenting with a barking cough and stridor?

• A. Administer a corticosteroid
• B. Obtain a throat culture
• C. Administer nebulized epinephrine
• D. Place the child in an upright position

Correct answer: C

Rationale: The priority action for a 2-year-old child with croup and stridor is to administer nebulized epinephrine. Nebulized epinephrine helps reduce airway swelling, alleviate symptoms, and improve breathing by causing vasoconstriction and reducing upper airway edema. Administering a corticosteroid may be done but is not the priority in this scenario. Obtaining a throat culture is not necessary for the immediate management of croup. Placing the child in an upright position can aid in breathing but is not the priority action when the child is presenting with stridor.

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