Nursing Elites

1. What is one of the most important factors that a healthcare professional must consider when parents of a toddler request to be present at a procedure occurring on the hospital unit?

• A. Type of procedure to be performed
• B. Individual assessment of the parents
• C. Whether the toddler wants the parents present
• D. Probable reaction to the toddler’s response to pain

Correct answer: B

Rationale: When parents of a toddler request to be present during a procedure, an individual assessment of the parents is crucial. This assessment helps healthcare professionals understand the parents' ability to cope with the situation, provide support to their child, and ensure a conducive environment for the procedure. Choice A is not as critical because the focus is on the parents' readiness rather than the specific procedure. Choice C, considering the toddler's desire, is important but not as crucial as assessing the parents. Choice D, anticipating the toddler's response to pain, is relevant but secondary to assessing the parents' readiness and support capabilities.

2. At 0345, you receive a call for a woman in labor. Upon arriving at the scene, you are greeted by a very anxious man who tells you that his wife is having her baby 'now.' This man escorts you into the living room where a 25-year-old woman is lying on the couch in obvious pain. After determining that delivery is not imminent, you begin transport. While en route, the mother tells you that she feels the urge to push. You assess her and see the top of the baby's head bulging from the vagina. What is your most appropriate first action?

• A. Allow the head to deliver and check for the location of the cord.
• B. Advise your partner to stop the ambulance and assist with the delivery.
• C. Tell the mother to take short, quick breaths until you arrive at the hospital.
• D. Prepare the mother for an emergency delivery and open the obstetrics kit.

Correct answer: B

Rationale: In this scenario, the most appropriate first action is to advise your partner to stop the ambulance and assist with the delivery. When the baby's head is visible and delivery is imminent, it is crucial to provide immediate assistance to ensure the safety of both the mother and the baby. Allowing the head to deliver and checking for the location of the cord (Choice A) may delay necessary actions during an imminent delivery. Instructing the mother to take short, quick breaths (Choice C) is not suitable as active delivery is already in progress. Preparing the mother for an emergency delivery and opening the obstetrics kit (Choice D) is not the most immediate action needed when the baby's head is already visible and delivery is imminent.

3. The nurse is teaching a father how to stimulate his 7-year-old son, who has a 'slow-to-warm-up' temperament. Which guidance will be most successful?

• A. Telling him to read stories to the child about famous athletes
• B. Suggesting he take the child to watch him play softball
• C. Urging him to sign the child up for little league football
• D. Proposing wrestling with the child and letting him win

Correct answer: A

Rationale: The correct answer is A. Reading stories to the child about famous athletes would be the most successful guidance for a child with a 'slow-to-warm-up' temperament. This approach allows for a less active and more acceptable way of engaging with the child, aligning better with the child's temperament. Choices B, C, and D involve more active and potentially overwhelming activities for a child with such a temperament, which may not be as effective in stimulating and engaging the child.

4. The parent of a 2-year-old child is informed by the nurse that the toddler’s negativism is expected at this age. What need is this behavior meeting?

• A. Trust
• B. Attention
• C. Discipline
• D. Independence

Correct answer: D

Rationale: Negativism in toddlers commonly occurs around the age of 2 as they begin to assert their independence and autonomy. At this stage, children are exploring their own will and preferences, leading to behaviors like defiance or negativism. Independence (choice D) is the primary need being met by this behavior as toddlers strive to establish their individuality and decision-making. While trust (choice A) is crucial for forming secure attachments, it is not the main need driving negativism in this case. Seeking attention (choice B) may be a behavior exhibited by children, but it is not the fundamental need being fulfilled by negativism. Discipline (choice C) is important for setting boundaries and teaching appropriate conduct, but it is not the primary need being addressed by negativism in toddlers.

5. A child has been admitted to the pediatric unit with a severe asthma attack. What type of acid-base imbalance should the nurse expect the child to develop?

• A. metabolic alkalosis caused by decreased acid metabolites production
• B. respiratory alkalosis caused by decreased respiratory rate and carbon dioxide retention
• C. respiratory acidosis caused by impaired respirations and increased carbonic acid formation
• D. metabolic acidosis caused by the kidneys' inability to compensate for increased carbonic acid production

Correct answer: C

Rationale: In a severe asthma attack, the child is likely to develop respiratory acidosis due to impaired respirations leading to the retention of carbon dioxide, which combines with water to form carbonic acid. This results in the pH imbalance characterized by an excess of carbonic acid. Choices A, B, and D are incorrect. Metabolic alkalosis (Choice A) is not typically associated with severe asthma attacks; respiratory alkalosis (Choice B) would involve a decrease, not an increase, in carbon dioxide levels; and metabolic acidosis (Choice D) is not the primary acid-base imbalance seen in severe asthma attacks.

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