Nursing Elites

1. Which immunization is typically administered at birth?

• A. Hepatitis B
• B. DTaP
• C. MMR
• D. Varicella

Correct answer: A

Rationale: The correct answer is A, Hepatitis B. The Hepatitis B vaccine is usually given at birth to protect against hepatitis B, a virus that can lead to chronic liver disease and liver cancer. This vaccination is crucial for newborns, especially those born to mothers who are carriers of hepatitis B. Choices B, C, and D are incorrect because DTaP (B), MMR (C), and Varicella (D) vaccines are not typically administered at birth. DTaP is given in a series starting at 2 months, MMR is usually given around 12-15 months, and Varicella is given between 12-15 months of age.

2. What statement is descriptive of renal transplantation in children?

• A. It is an acceptable means of treatment after age 10 years.
• B. Children can receive kidneys only from other children.
• C. It is the preferred means of renal replacement therapy in children.
• D. The decision for transplantation is difficult because a relatively normal lifestyle is not possible.

Correct answer: C

Rationale: Renal transplantation is the preferred method of treatment for children with end-stage renal disease, as it offers the best chance for a normal lifestyle compared to long-term dialysis. Transplantation can be performed at any age, and kidneys can come from adult donors as well.

3. According to Erikson’s theory of psychosocial development, the school-age child is in which stage?

• A. Industry vs. inferiority
• B. Autonomy vs. shame and doubt
• C. Identity vs. role diffusion
• D. Trust vs. mistrust

Correct answer: A

Rationale: The correct answer is A: 'Industry vs. inferiority.' According to Erikson’s theory, school-age children (approximately 6-12 years old) are in the stage of industry vs. inferiority. In this stage, children focus on developing a sense of competence and productivity. Choice B, 'Autonomy vs. shame and doubt,' is incorrect as it refers to the stage that occurs during early childhood (1-3 years old). Choice C, 'Identity vs. role diffusion,' pertains to adolescence (12-18 years old). Choice D, 'Trust vs. mistrust,' is related to the stage of infancy (0-1 year old). Therefore, option A is the most appropriate stage for school-age children in Erikson's theory.

4. A 6-month-old infant with Hirschsprung disease is scheduled for a temporary colostomy. What should postoperative teaching to the parents include?

• A. Dilating the stoma
• B. Assessing bowel function
• C. Limitation of physical activities
• D. Measures to prevent prolapse of the rectum

Correct answer: B

Rationale: Postoperative teaching should focus on assessing bowel function to ensure the colostomy is functioning properly. This includes monitoring stool output, color, consistency, and signs of infection or blockage. Choice A, dilating the stoma, is not recommended without healthcare provider guidance, as it can lead to complications. Choice C, limitation of physical activities, may not be as crucial immediately after colostomy creation. Choice D, measures to prevent prolapse of the rectum, is more relevant for conditions like rectal prolapse and not specifically for a colostomy.

5. The nurse is caring postoperatively for an 8-year-old child with multiple fractures and other traumatic injuries from a motor vehicle crash. The child is experiencing severe pain. What is an important consideration in managing the child’s pain?

• A. Give only an opioid analgesic at this time.
• B. Increase the dosage of analgesic until the child is adequately sedated.
• C. Plan a preventive schedule of pain medication around the clock.
• D. Give the child a clock and explain when they can have pain medications.

Correct answer: C

Rationale: For severe postoperative pain, a preventive around-the-clock schedule is necessary to prevent decreased plasma levels of medications. Providing only an opioid analgesic at this time may not be sufficient for effective pain management. Increasing the dosage without an order is unsafe and may lead to oversedation. Planning a preventive schedule of pain medication around the clock ensures consistent pain relief and better management. Giving the child a clock and explaining when they can have pain medications may increase the child's focus on waiting for relief rather than addressing the pain promptly, making it a less effective strategy.

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