Nursing Elites

1. When developing the plan of care for a child with cerebral palsy, which treatment would the nurse expect as least likely?

• A. Skeletal traction
• B. Physical therapy
• C. Orthotics
• D. Occupational therapy

Correct answer: A

Rationale: In caring for a child with cerebral palsy, skeletal traction is least likely to be a part of the treatment plan. Cerebral palsy is a neurological disorder affecting movement and muscle coordination, and skeletal traction, which involves applying a pulling force on a bone to correct alignment, is not a common intervention for this condition. Physical therapy, orthotics, and occupational therapy are more commonly used in the management of cerebral palsy. Physical therapy helps improve mobility and strength, orthotics assist in supporting and aligning the body, and occupational therapy focuses on enhancing daily living skills and independence. Therefore, skeletal traction is the least likely treatment option among the choices provided.

2. The parents of a newborn with phenylketonuria (PKU) need help and support in adhering to specific dietary restrictions. They ask the nurse, “How long will our child have to be on this diet?” How should the nurse respond?

• A. “We are still not sure; you should discuss this with your health care provider.”
• B. “If your baby does well, foods containing protein can gradually be introduced.”
• C. “Your child needs to be on this diet at least through adolescence and into adulthood.”
• D. “This is a lifelong problem, and it is recommended that dietary restrictions must be continued.”

Correct answer: D

Rationale: The correct answer is D: “This is a lifelong problem, and it is recommended that dietary restrictions must be continued.” Phenylketonuria (PKU) is a metabolic disorder where the body cannot process phenylalanine properly. The diet for PKU must be continued lifelong to prevent cognitive and developmental issues, as phenylalanine buildup can cause irreversible damage. Choice A is incorrect because the nurse should provide information about the lifelong nature of the dietary restrictions for PKU. Choice B is incorrect as it suggests reintroducing protein-containing foods, which is not recommended for individuals with PKU. Choice C is incorrect as it underestimates the duration of the necessary dietary restrictions for PKU.

3. The parents of a 1-month-old girl with Down syndrome are being taught by the nurse on how to maintain the child's good health. Which instruction would the nurse be least likely to include?

• A. Getting cervical radiographs between 3 and 5 years of age
• B. Adhering to the special dietary needs of the child
• C. Getting an echocardiogram before 3 months of age
• D. Monitoring for symptoms of respiratory infection

Correct answer: B

Rationale: The correct answer is B. While special dietary needs may be important, they are not typically a primary concern for a 1-month-old with Down syndrome compared to monitoring for congenital issues. Getting cervical radiographs, an echocardiogram, and monitoring for respiratory infections are more crucial in the early care of a child with Down syndrome. Cervical radiographs help in assessing for atlantoaxial instability, an echocardiogram is important for detecting congenital heart defects common in Down syndrome, and monitoring for respiratory infections is vital due to the increased risk in these children.

4. Upon assessing a newborn immediately after delivery, you note that the infant is breathing spontaneously and has a heart rate of 90 beats/min. What is the most appropriate initial management for this newborn?

• A. begin positive pressure ventilations
• B. provide blow-by oxygen with oxygen tubing
• C. assess the newborn's skin condition and color
• D. start chest compressions and contact medical control

Correct answer: A

Rationale: A heart rate below 100 beats/min in a newborn indicates the need for positive pressure ventilation to improve oxygenation. Providing positive pressure ventilations helps in assisting the newborn's breathing efforts to ensure adequate oxygenation. Choice B, providing blow-by oxygen, may not be sufficient to address the underlying issue of inadequate breathing. Choice C, assessing the newborn's skin condition and color, is important but not the most immediate action needed for a heart rate below 100 beats/min. Choice D, starting chest compressions, is not indicated as the infant is breathing spontaneously and has a heart rate, albeit lower than normal, which does not warrant chest compressions.

5. A nurse is teaching the parents of a toddler about the signs and symptoms of lead poisoning. Which symptom should the nurse emphasize?

• A. Abdominal pain
• B. Constipation
• C. Irritability
• D. Frequent urination

Correct answer: C

Rationale: Irritability is a significant symptom of lead poisoning in toddlers and should be emphasized to parents. Lead poisoning can manifest with various symptoms, but irritability is particularly common in children exposed to lead. Abdominal pain (Choice A) is not a typical symptom of lead poisoning in toddlers. While constipation (Choice B) can occur, it is less specific and less common than irritability. Frequent urination (Choice D) is not a typical symptom associated with lead poisoning in toddlers and is less relevant for parents to recognize in this context.

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