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. What information should be reinforced with the mother of a child with ringworm (Tinea)?

• A. Ringworm is not contagious.
• B. Tinea infections are indicative of poor hygiene and uncleanliness.
• C. Tinea infections are spread by direct and indirect contact.
• D. Ringworm often subsides spontaneously.

Correct answer: C

Rationale: The correct answer is C. Ringworm, a fungal infection, is highly contagious and can be spread by direct contact with infected individuals or animals and indirectly through contaminated objects. It is important for the mother to understand the modes of transmission to prevent the spread of the infection to others and to take necessary precautions to ensure proper treatment and containment of the condition. Choices A and D are incorrect because ringworm is indeed contagious, and it may not always subside spontaneously. Choice B is misleading as tinea infections are not solely indicative of poor hygiene; they can affect anyone, regardless of personal cleanliness.

3. The practical nurse is caring for a child with suspected appendicitis. Which assessment finding should be reported to the healthcare provider immediately?

• A. Nausea and vomiting.
• B. Sudden relief of pain.
• C. Low-grade fever.
• D. Rebound tenderness.

Correct answer: B

Rationale: Sudden relief of pain in a child with suspected appendicitis should be reported immediately as it may indicate a rupture of the appendix, which is a medical emergency. Sudden relief of pain is concerning because it can be a sign of a perforated appendix, leading to peritonitis and sepsis.

4. A 4-month-old girl is brought to the clinic by her mother because she has had a cold for 2 or 3 days and woke up this morning with a hacking cough and difficulty breathing. Which additional assessment finding should alert the nurse that the child is in acute respiratory distress?

• A. Bilateral bronchial breath sounds.
• B. Diaphragmatic breathing.
• C. A resting respiratory rate of 35 breaths per minute.
• D. Flaring of the nares.

Correct answer: D

Rationale: Flaring of the nares is a classic sign of acute respiratory distress in infants. It indicates increased work of breathing and is a visible cue that the child is struggling to breathe. This finding should alert healthcare providers to the severity of the respiratory distress and the need for prompt intervention to support the child's breathing. Choices A, B, and C are incorrect. Bilateral bronchial breath sounds are associated with conditions like pneumonia, but they do not specifically indicate acute respiratory distress. Diaphragmatic breathing is a normal breathing pattern and not a sign of distress. A resting respiratory rate of 35 breaths per minute is within the expected range for a 4-month-old infant and does not necessarily indicate acute respiratory distress.

5. A 6-year-old child with a history of asthma is brought to the clinic with complaints of wheezing and shortness of breath. The nurse notes that the child is using accessory muscles to breathe. What should the nurse do first?

• A. Administer a bronchodilator
• B. Obtain a peak flow reading
• C. Apply oxygen
• D. Perform a complete respiratory assessment

Correct answer: A

Rationale: Administering a bronchodilator is the initial priority as it helps open the child's airways, reducing the wheezing and shortness of breath. This intervention aims to provide immediate relief and improve the child's respiratory distress. Obtaining a peak flow reading or applying oxygen may be necessary after administering the bronchodilator, but the priority is to address the acute symptoms of wheezing and shortness of breath first. Performing a complete respiratory assessment can be done after the immediate intervention of administering the bronchodilator to further evaluate the child's respiratory status.

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