Nursing Elites

1. The parents of a child with sickle cell anemia ask why their child did not have a sickle cell crisis until he was approximately 6 months old. How should the nurse respond?

• A. Your child probably had a crisis, and you were unaware of the symptoms.
• B. Are you sure your child has sickle cell anemia and not sickle cell trait?
• C. Affected children can be asymptomatic in early infancy because of high levels of fetal hemoglobin that inhibit sickling.
• D. Have you asked your doctor about this yet?

Correct answer: C

Rationale: The correct answer is C. Fetal hemoglobin (HbF) is present in high levels during early infancy, inhibiting sickling unlike adult hemoglobin (HbS). As the levels of HbF decrease and HbS increases, the risk of sickling and crises becomes more pronounced, typically after 6 months of age. Choice A is incorrect because it assumes the crisis went unnoticed, which is not supported by medical knowledge. Choice B is incorrect as it questions the child's diagnosis rather than explaining the phenomenon of delayed crises. Choice D is incorrect as it does not provide the parents with the necessary information regarding their query.

2. What do the clinical manifestations of minimal change nephrotic syndrome include?

• A. Hematuria, bacteriuria, and weight gain
• B. Gross hematuria, albuminuria, and fever
• C. Hypertension, weight loss, and proteinuria
• D. Massive proteinuria, hypoalbuminemia, and edema

Correct answer: D

Rationale: Minimal change nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, and edema due to the loss of protein in the urine. Hematuria, bacteriuria, and weight loss are not typical features of this condition.

3. An adolescent patient wants to make decisions about treatment options, along with his parents. Which moral value is the nurse displaying when supporting the adolescent to make decisions?

• A. Justice
• B. Autonomy
• C. Beneficence
• D. Nonmaleficence

Correct answer: B

Rationale: Supporting an adolescent in making decisions about their care reflects the moral value of autonomy, emphasizing the importance of respecting the patient's right to make informed choices.

4. A teenager is accompanied by his mother to the annual physical examination. The nurse is aware of privacy issues related to the teenager. While the mother is in the room, which topic should the nurse avoid?

• A. School performance
• B. Seatbelt use
• C. Cigarette smoking
• D. School friends

Correct answer: C

Rationale: The correct answer is C: Cigarette smoking. Discussing sensitive topics like cigarette smoking in the presence of a parent may inhibit the teenager's willingness to be open and honest. It's important to provide an opportunity for the teenager to speak privately with the healthcare provider. Choices A, B, and D are more general topics that can be discussed openly in front of the parent without compromising the teenager's privacy or comfort.

5. Which vaccine is contraindicated in a child with a history of severe egg allergy?

• A. MMR
• B. Varicella
• C. Influenza
• D. Hepatitis B

Correct answer: C

Rationale: The correct answer is C: Influenza. The influenza vaccine is produced using egg-based technology, so individuals with a severe egg allergy are at risk of an allergic reaction if vaccinated with the influenza vaccine. This is due to the potential presence of egg proteins in the vaccine. Choices A, B, and D are not contraindicated in children with severe egg allergy. The MMR and Varicella vaccines do not pose a risk for children with egg allergies, and the Hepatitis B vaccine is also safe for these individuals.

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