Nursing Elites

1. What is it called when the therapist adjusts the difficulty level of an activity to match the child's abilities by bringing a toy closer for them to successfully reach and grasp during therapy?

• A. Compensating
• B. Adapting
• C. Grading
• D. Modifying

Correct answer: C

Rationale: The correct answer is C: Grading. Grading involves adjusting the difficulty level of an activity to match the child's abilities. Bringing a toy closer for easier reach is an example of grading in therapy, helping the child succeed in reaching and grasping the toy within their current capabilities. Choice A, Compensating, implies making up for a deficit, which is not the case here. Choice B, Adapting, suggests changing the activity itself, not just the difficulty level. Choice D, Modifying, indicates altering the toy or the task itself, rather than adjusting the task's difficulty level.

2. Which is the appropriate intervention when providing care to a child diagnosed with nephrotic syndrome, who is edematous and on bed rest?

• A. Monitor blood pressure every 30 minutes.
• B. Reposition every 2 hours.
• C. Limit visitors.
• D. Encourage fluids.

Correct answer: B

Rationale: Repositioning every 2 hours is crucial in preventing skin breakdown in an edematous child on bed rest. This intervention helps redistribute pressure and maintain skin integrity, reducing the risk of pressure ulcers. It is an essential part of care for patients with limited mobility to ensure their comfort and prevent complications related to immobility.

3. A teacher states to the school nurse, 'I have a student who will often just stare at me for 15 seconds after asking a question; then the student blinks and asks me to repeat the question. Should I be concerned?' Which should the nurse include in the response to the teacher?

• A. The child has a crush on the teacher.
• B. The child has increased intracranial pressure.
• C. The child may have had a head injury.
• D. The child is experiencing absence seizures.

Correct answer: D

Rationale: Staring spells that end abruptly and are followed by normal activity are indicative of absence seizures. In absence seizures, a child may exhibit staring spells, brief loss of awareness, and lack of responsiveness, which can last for a few seconds. Choice A is incorrect because the behavior described is not associated with having a crush. Choice B is incorrect as increased intracranial pressure usually presents with other symptoms. Choice C is less likely as a head injury would typically manifest with additional signs beyond just staring and blinking.

4. A school nurse is assessing a school-age child�s blood pressure while he is seated in a chair. The child starts to experience a tonic-clonic seizure. Which of the following actions should the nurse take first?

• A. Clear the immediate area around the child of hazardous objects
• B. loosen the child�s restrictive clothing
• C. assist the child to a side-lying position on the floor
• D. apply an oxygen mask to the child

Correct answer: C

Rationale: The greatest risk to this child is aspiration, occlusion of the airway, and bodily injury from falling out of the chair. The nurse should ease the child down to the floor in a side-lying position immediately.

5. Which assessment finding for a 4-month-old infant would require further action by the nurse?

• A. The posterior fontanel is open.
• B. The infant has good head control when held upright.
• C. The infant is able to roll only from abdomen to back.
• D. The anterior fontanel is open and soft.

Correct answer: A

Rationale: The correct answer is A. The posterior fontanel should be closed by 4 months of age. An open posterior fontanel at this age may indicate a delay in normal closure, which could be a cause for concern and require further evaluation by the healthcare provider to ensure proper development and growth. Choices B, C, and D are typical developmental milestones for a 4-month-old infant and do not raise immediate concerns requiring further action by the nurse.

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