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. The nurse should assess which age group for suicide ideation since suicide in which age group is the third leading cause of death?

• A. Preschoolers
• B. Young school age
• C. Middle school age
• D. Late school age and adolescents

Correct answer: D

Rationale: Suicide is the third leading cause of death in late school-age children and adolescents, requiring careful assessment for ideation in these age groups.

3. A child who has just had definitive repair of a high rectal malformation is to be discharged. What should the nurse address in the discharge preparation of this family?

• A. Safe administration of daily enemas
• B. Necessity of firm stools to keep suture line clean
• C. Bowel training beginning as soon as the child returns home
• D. Changes in stooling patterns to report to the practitioner

Correct answer: D

Rationale: Postoperative care should focus on monitoring changes in stooling patterns, which could indicate complications such as stenosis or obstruction. It is crucial to educate the family on the importance of promptly reporting any changes in stooling patterns to the healthcare provider. Options A and B are not recommended unless specifically ordered by the physician as they can potentially cause harm or discomfort postoperatively. Option C may not be appropriate immediately after surgery and should be guided by the healthcare provider's recommendations.

4. Which is the single most important factor to consider when communicating with children?

• A. Presence of the child's parent
• B. Child’s physical condition
• C. Child’s developmental level
• D. Child’s nonverbal behaviors

Correct answer: C

Rationale: The child’s developmental level is the most important factor, as it determines how information should be communicated and what the child can understand.

5. At which age should the nurse expect most infants to begin to say mama and dada with meaning?

• A. 4 months
• B. 6 months
• C. 10 months
• D. 14 months

Correct answer: C

Rationale: By around 10 months, infants often start to say "mama" and "dada" with meaning, associating these words with their parents.

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