Nursing Elites

1. What self-report pain rating scales can be used in children as young as 3 years of age?

• A. Poker Chip Tool
• B. Visual Analog Scale
• C. FACES Pain Rating Scale
• D. Word-Graphic Rating Scale

Correct answer: C

Rationale: The FACES Pain Rating Scale is suitable for children as young as 3 years of age. It uses facial expressions to depict different levels of pain, making it easy for young children to understand and use. The Poker Chip Tool is validated for children aged 4 and older who have a certain level of cognitive ability. The Visual Analog Scale is more appropriate for children aged 7 and above. The Word-Graphic Rating Scale, which uses descriptive words, is recommended for children in the age range of 4 to 17 years.

2. When doing a nutritional assessment on a Hispanic family, the nurse learns that their diet consists mainly of vegetables, legumes, and starches. The nurse should recognize that this diet is which?

• A. Lacking in protein
• B. Indicating they live in poverty
• C. Providing sufficient amino acids
• D. Needing enrichment with meat and milk

Correct answer: C

Rationale: A diet rich in vegetables, legumes, and starches can provide sufficient amino acids, particularly when complemented with varied food sources to ensure a balanced intake of essential nutrients.

3. Why does the nurse have a 2-year-old boy sit in a “tailor” position while palpating for the presence of the testes?

• A. It prevents the cremasteric reflex
• B. Undescended testes can be palpated
• C. The child has an inguinal hernia
• D. The child does not yet have a need for privacy

Correct answer: A

Rationale: The tailor position stretches the muscle responsible for the cremasteric reflex, preventing it from contracting and pulling the testes into the pelvic cavity. This position helps accurately palpate the testes. Choice B is incorrect because the position does not facilitate the palpation of undescended testes specifically. Choice C is incorrect as it does not relate to the rationale behind the tailor position. Choice D is incorrect as the reason for using the tailor position is not related to the child's need for privacy.

4. All of the following statements are true regarding the value of play except:

• A. Play helps preschoolers develop moral values
• B. Play helps develop muscle coordination, uses energy, and develops self-confidence
• C. Play is the work of children
• D. Play is not an effective way for the nurse to establish rapport with the child

Correct answer: D

Rationale: Play is an effective way to establish rapport with children as it helps build trust, communication, and a positive relationship. Choices A, B, and C are true statements about the value of play: A) Play helps preschoolers develop moral values by promoting social skills, cooperation, and empathy. B) Play aids in developing muscle coordination, utilizing energy, and fostering self-confidence through physical activities. C) 'Play is the work of children' emphasizes the importance of play in a child's development, learning, and creativity. Therefore, D is the correct answer as it incorrectly suggests that play is not an effective way for the nurse to establish rapport with the child.

5. An infant is diagnosed with a tracheoesophageal fistula. Which assessment finding should the nurse expect?

• A. Jaundice
• B. Hyperactive bowel sounds
• C. Absence of sucking, vomiting
• D. Coughing, with excessive secretion

Correct answer: D

Rationale: Coughing with excessive secretion is a common sign of tracheoesophageal fistula. In this condition, the connection between the trachea and esophagus allows saliva and food to enter the airways, leading to coughing and excessive secretions. Choice A, jaundice, is not typically associated with tracheoesophageal fistula. Hyperactive bowel sounds (Choice B) are more likely seen in conditions like gastroenteritis. Absence of sucking and vomiting (Choice C) is not a typical finding related to tracheoesophageal fistula.

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