Nursing Elites

1. Before administering a tube feeding to a child, what should the practical nurse (PN) assess?

• A. Tube placement.
• B. Bowel sounds.
• C. Abdominal circumference.
• D. Tube patency.

Correct answer: A

Rationale: Assessing tube placement is critical before initiating a tube feeding to verify its correct positioning in the stomach. This assessment helps prevent potential complications such as aspiration if the tube is incorrectly placed in the respiratory tract. Checking bowel sounds, abdominal circumference, and tube patency are important assessments in the care of a child receiving tube feedings, but ensuring proper tube placement takes precedence to ensure safe and effective delivery of nutrition.

2. A child who is admitted to the hospital with anemia is anxious, fearful, and hyperventilating. The nurse anticipates the child developing which acid-base imbalance?

• A. Metabolic acidosis
• B. Respiratory acidosis
• C. Respiratory alkalosis
• D. Metabolic alkalosis

Correct answer: C

Rationale: In this scenario, the child is hyperventilating, which leads to excessive loss of carbon dioxide. This loss of carbon dioxide causes respiratory alkalosis due to a decrease in the partial pressure of carbon dioxide in the blood. Therefore, the correct answer is respiratory alkalosis. Choices A, B, and D are incorrect. Metabolic acidosis is characterized by a decrease in pH and bicarbonate levels due to conditions like kidney disease. Respiratory acidosis is caused by retention of carbon dioxide, leading to an increase in the partial pressure of carbon dioxide. Metabolic alkalosis results from a loss of acid or an increase in bicarbonate levels.

3. A child with cystic fibrosis is being discharged home with pancreatic enzyme replacement therapy. What information should the practical nurse reinforce with the parents?

• A. Give the enzymes after meals.
• B. Mix the enzymes with hot food or drinks.
• C. Enzymes should be taken before or with meals.
• D. Avoid giving enzymes with any food or drink.

Correct answer: C

Rationale: The correct answer is C: 'Enzymes should be taken before or with meals.' Pancreatic enzymes should be taken before or with meals to assist with digestion in children with cystic fibrosis. This timing helps maximize the effectiveness of the enzymes in breaking down nutrients from food. Giving the enzymes after meals (choice A) may not provide the necessary support for digestion. Mixing the enzymes with hot food or drinks (choice B) is not recommended as it may affect the enzymes' efficacy. Avoiding giving enzymes with any food or drink (choice D) is incorrect as enzymes need to be taken in conjunction with meals to aid in digestion.

4. What information should the nurse provide to parents of a 3-year-old boy with Duchenne muscular dystrophy who inquire about the disease and future children?

• A. This is an inherited X-linked recessive disorder, which primarily affects male children in the family
• B. The striated muscle groups of males can be impacted by a lack of the protein dystrophin in their mothers
• C. The male infant had a viral infection that went unnoticed and untreated so muscle damage was incurred
• D. Birth trauma with a breech vaginal birth causes damage to the spinal cord, thus weakening the muscles

Correct answer: A

Rationale: Duchenne muscular dystrophy is an X-linked recessive disorder caused by mutations in the DMD gene on the X chromosome. This disorder primarily affects males because they have one X chromosome, inherited from their mothers, who may be carriers of the mutated gene. Females have two X chromosomes, providing a protective effect as the normal gene on one X chromosome can compensate for the mutated gene on the other. Therefore, the nurse should explain to the parents that Duchenne muscular dystrophy is an inherited X-linked recessive disorder, which is why their son has the disease and why there is a risk of passing it on to future sons. Choice B is incorrect as it inaccurately implies that the lack of dystrophin in mothers impacts their sons' muscle groups. Choice C is incorrect as it suggests a viral infection caused the muscle damage, which is not the case with Duchenne muscular dystrophy. Choice D is incorrect as it attributes the muscle weakness to birth trauma instead of the genetic nature of the disorder.

5. The nurse is providing care for a 12-year-old child who was recently diagnosed with scoliosis. The child’s parent asks about treatment options. What is the nurse’s best response?

• A. Scoliosis can be corrected with exercises and physical therapy.
• B. Bracing is often recommended to prevent further curvature of the spine.
• C. Surgery is usually necessary for all cases of scoliosis.
• D. There is no effective treatment for scoliosis.

Correct answer: B

Rationale: Bracing is commonly used in moderate cases of scoliosis to prevent progression of the spinal curvature. Choice A is incorrect because exercises and physical therapy can help manage scoliosis but may not correct it. Choice C is incorrect as surgery is usually reserved for severe cases of scoliosis that do not respond to other treatments. Choice D is incorrect because there are effective treatments available for scoliosis, such as bracing, and surgery when necessary.

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