Nursing Elites

1. Which assessment data would cause suspicion that a 3-year-old child has Hirschsprung disease?

• A. Clay-colored stools and dark urine
• B. History of early passage of meconium in the newborn period
• C. History of chronic, progressive constipation and failure to gain weight
• D. Continual bouts of foul-smelling diarrhea

Correct answer: C

Rationale: Hirschsprung disease is characterized by chronic, progressive constipation and failure to gain weight. These symptoms are indicative of the disorder due to the absence of ganglion cells in the distal colon, leading to impaired motility and obstruction.

2. When educating a parent of a child with HIV, which statement indicates an understanding of the teaching?

• A. I will notify my child's school about their condition.
• B. I will give my child the prescribed antiretroviral medication at regular intervals.
• C. I will expect my child to receive yearly immunizations.
• D. I will bring my child in for yearly skin testing.

Correct answer: B

Rationale: The correct answer is B because ensuring the child receives the prescribed antiretroviral medication at regular intervals is crucial in maintaining therapeutic levels and preventing drug resistance in a child with HIV. Choices A, C, and D are incorrect because notifying the school about the condition, expecting yearly immunizations, and bringing the child in for yearly skin testing do not directly address the essential aspect of medication adherence, which is fundamental in managing HIV in children.

3. In the morning, a healthcare professional receives change-of-shift report on four pediatric clients, each of whom has some form of fluid-volume excess. Which of the children should the healthcare professional see first?

• A. The child with tachypnea and pulmonary congestion
• B. The child with hepatomegaly and normal respiratory rate
• C. The child with dependent and sacral edema and regular pulse
• D. The child with periorbital edema and normal respiratory rate

Correct answer: A

Rationale: The child with tachypnea and pulmonary congestion should be seen first. Tachypnea indicates an increased respiratory rate, a sign of possible respiratory distress. Pulmonary congestion suggests fluid accumulation in the lungs, posing a serious risk to respiratory function. Immediate attention is crucial in this case. Choice B is incorrect as hepatomegaly alone does not indicate an acute issue requiring immediate attention. Choices C and D, while showing signs of fluid-volume excess, do not present the same level of respiratory compromise as tachypnea and pulmonary congestion, making them lower priority.

4. A parent of a child with attention deficit hyperactivity disorder (ADHD) is being taught by a nurse. Which instruction should the nurse include in the teaching?

• A. Administer methylphenidate at bedtime.
• B. Increase stimuli in the child's environment.
• C. Administer an extra dose of medication if the child is overactive.
• D. Maintain a consistent bedtime routine.

Correct answer: D

Rationale: Maintaining a consistent bedtime routine is essential for children with ADHD as it helps in managing their symptoms effectively. Consistency in bedtime routines aids in regulating the child's sleep patterns, promoting better rest, and ultimately improving their behavior and focus during the day.

5. A 9-month-old infant who is not sitting independently has been diagnosed with ataxic cerebral palsy (CP). Which clinical manifestations would the nurse expect to see in the baby?

• A. Hypotonia and muscle instability
• B. Hypertonia and persistence of primitive reflexes
• C. Tremors and exaggerated posturing
• D. Hemiplegia and hypertonia

Correct answer: A

Rationale: In ataxic cerebral palsy, the characteristic features include hypotonia (low muscle tone) and muscle instability. These manifestations contribute to the infant's difficulty in achieving independent sitting. Hypertonia (increased muscle tone) and persistence of primitive reflexes, as mentioned in option B, are more commonly associated with other types of cerebral palsy like spastic CP. Tremors and exaggerated posturing (option C) are not typical features of ataxic CP. Hemiplegia (paralysis of one side of the body) and hypertonia (increased muscle tone) mentioned in option D are more commonly seen in other types of cerebral palsy, such as spastic CP.

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