Nursing Elites

1. What information should the nurse provide the parents of a 3-year-old boy with Duchenne muscular dystrophy (DMD) who are concerned about having more children?

• 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 mother's lack of the protein dystrophin can impact the XXXX muscle groups in males.
• D. Birth trauma during a breech vaginal birth can damage the spinal cord, resulting in muscle weakness.

Correct answer: A

Rationale: The correct answer is A. Duchenne muscular dystrophy is an inherited X-linked recessive disorder that primarily affects male children in the family. Since it is X-linked, sons inherit the mutation from their mothers who are carriers of the abnormal gene. Therefore, the nurse should explain to the parents that any future sons they have would have a 50% chance of inheriting the mutation and having DMD, while daughters would have a 50% chance of being carriers like the mother.

2. A 2-year-old is admitted to the hospital with possible encephalitis, and a lumbar puncture is scheduled. Which information should the nurse provide this child concerning the procedure?

• A. Describe the side-lying, knees-to-chest position that must be assumed during the procedure.
• B. Explain that fluids cannot be taken for 8 hours before the procedure and for 4 hours after the procedure.
• C. Reassure the child that there will be no restrictions on activity after the procedure is completed.
• D. Tell the child to expect loud clicking noises during the procedure that may be slightly annoying.

Correct answer: A

Rationale: Children, especially young ones, benefit from knowing what position they will be in during a procedure as it helps them understand and feel more in control. Describing the side-lying, knees-to-chest position can reduce anxiety and promote cooperation during the lumbar puncture. Choice B is incorrect because the question is about preparing the child for the procedure, not about pre-procedure fasting requirements. Choice C is incorrect because there may be restrictions on activity after the procedure. Choice D is incorrect because mentioning loud clicking noises may increase the child's anxiety and fear.

3. A 3-year-old child is admitted to the hospital with a diagnosis of pneumonia. The nurse notes that the child has a fever and is breathing rapidly. What is the nurse’s priority action?

• A. Administer antipyretic medication
• B. Obtain a chest X-ray
• C. Start the child on oxygen therapy
• D. Notify the healthcare provider

Correct answer: C

Rationale: In a child with pneumonia who is breathing rapidly, the priority action for the nurse is to start the child on oxygen therapy. This intervention is essential to ensure adequate oxygenation, which is crucial in managing respiratory distress and preventing complications associated with hypoxia. Administering antipyretic medication (Choice A) may help reduce the fever but does not address the immediate need for oxygen therapy. Obtaining a chest X-ray (Choice B) is important for diagnosis but providing oxygen is more urgent. Notifying the healthcare provider (Choice D) can be done after initiating oxygen therapy to update on the patient's condition.

4. A 2-year-old child with a history of frequent ear infections is brought to the clinic by the parents who are concerned about the child’s hearing. What should the nurse do first?

• A. Ask the parents about the child’s speech development
• B. Perform a hearing test
• C. Inspect the child’s ears for drainage
• D. Refer the child to an audiologist

Correct answer: C

Rationale: The most appropriate initial action for the nurse to take is to inspect the child's ears for drainage. This step can provide immediate information on the presence of infection or fluid, which could be impacting the child's hearing. By assessing for drainage, the nurse can gather valuable initial data to determine the next course of action, such as further evaluation or treatment. Asking about speech development or referring to an audiologist would be secondary steps after assessing the physical condition of the ears. Performing a hearing test would also be premature without first examining the ears for any visible issues.

5. The healthcare provider is preparing a teaching plan for the parents of a 6-month-old infant with GERD. What instruction should the healthcare provider include when teaching the parents measures to promote adequate nutrition?

• A. Alternate glucose water with formula
• B. Mix the formula with rice cereal
• C. Add multivitamins with iron to the formula
• D. Use water to dilute the formula

Correct answer: B

Rationale: The correct instruction for promoting adequate nutrition in a 6-month-old infant with GERD is to mix the formula with rice cereal. This thickens the feed, reducing the risk of reflux, aiding in proper nutrition, and minimizing GERD symptoms. Choices A, C, and D are incorrect. Alternating glucose water with formula, adding multivitamins with iron to the formula, or diluting the formula with water are not recommended measures for promoting adequate nutrition in infants with GERD.

Similar Questions