Nursing Elites

1. When teaching a class about trisomy 21, the instructor would identify the cause of this disorder as:

• A. nondisjunction.
• B. X-linked recessive inheritance.
• C. genomic imprinting.
• D. autosomal dominant inheritance.

Correct answer: A

Rationale: The correct answer is A: nondisjunction. Trisomy 21, also known as Down syndrome, is caused by nondisjunction, which is an error in cell division leading to an extra copy of chromosome 21. This additional genetic material alters the course of development and causes the characteristics associated with Down syndrome. Choices B, C, and D are incorrect. X-linked recessive inheritance refers to genetic disorders carried on the X chromosome, genomic imprinting involves gene expression based on parental origin, and autosomal dominant inheritance relates to disorders caused by a dominant gene on one of the non-sex chromosomes. In the case of trisomy 21, the cause is specifically related to the error in chromosome division, making nondisjunction the most appropriate answer.

2. 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.

3. The nurse volunteering at a homeless shelter to assist families with children identifies homelessness as a risk preventing families from achieving positive outcomes in life. What family theory encompasses this approach to assessing family dynamics?

• A. Duvall's developmental theory
• B. Friedman's structural functional theory
• C. Von Bertalanffy's general system theory applied to families
• D. Resiliency model of family stress, adjustment, and adaptation

Correct answer: D

Rationale: The Resiliency model of family stress, adjustment, and adaptation is the appropriate theory in this scenario. This model focuses on identifying risks and protective factors that help families achieve positive outcomes despite challenges. Duvall's developmental theory primarily focuses on family life cycle stages, Friedman's structural functional theory emphasizes the interdependence of family members, and Von Bertalanffy's general system theory applied to families looks at the family as a dynamic system. These theories do not specifically address the concept of resilience and adaptation in the face of stressors like homelessness.

4. You are managing a 10-month-old infant who has had severe diarrhea and vomiting for 3 days and is now showing signs of shock. You have initiated supplemental oxygen therapy and elevated the lower extremities. En route to the hospital, you note that the child's work of breathing has increased. What must you do first?

• A. Lower the extremities and reassess the child
• B. Begin positive pressure ventilations and reassess the child
• C. Place a nasopharyngeal airway and increase the oxygen flow
• D. Listen to the lungs with a stethoscope for abnormal breath sounds

Correct answer: A

Rationale: In this scenario, the infant is presenting with signs of respiratory distress, as evidenced by the increased work of breathing. Lowering the extremities can help reduce the workload on the diaphragm and improve respiratory mechanics. This action can be beneficial in optimizing the infant's breathing before considering more invasive interventions. Option B, initiating positive pressure ventilations, should be considered if the infant's condition deteriorates further and not as the first step. Option C, placing a nasopharyngeal airway and increasing oxygen flow, is not indicated as the primary intervention for increased work of breathing. Option D, listening to the lungs with a stethoscope, may provide additional information but is not the most urgent action needed in this situation.

5. A 2-year-old child who was admitted to the hospital for further surgical repair of a clubfoot is standing in the crib, crying. The child refuses to be comforted and calls for the mother. As the nurse approaches the crib to provide morning care, the child screams louder. Knowing that this behavior is typical of the stage of protest, what is the most appropriate nursing intervention?

• A. Use comforting measures while holding the child.
• B. Fill the basin with water and bathe the child.
• C. Sit by the crib and bathe the child later when the anxiety decreases.
• D. Postpone the bath for a day because a child this upset should not be traumatized further.

Correct answer: C

Rationale: During the stage of protest, children may display distress when separated from their primary caregiver. Sitting by the crib and providing comfort when the child is less anxious is an appropriate intervention. Choice A is incorrect because attempting to hold the child while they are in distress may escalate the situation. Choice B is inappropriate as it ignores the child's emotional distress and proceeds with a task that can wait. Choice D is not the best option as postponing the bath for a day is not necessary; instead, addressing the child's emotional needs promptly is crucial in this situation.

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