Nursing Elites

1. Which laboratory test would be most important for the nurse to assess when caring for a toddler suspected of having cystic fibrosis?

• A. Liver enzymes
• B. Serum calcium
• C. Sweat chloride test
• D. Urine creatinine

Correct answer: C

Rationale: The sweat chloride test is the primary diagnostic test for cystic fibrosis. Cystic fibrosis is characterized by abnormal transport of chloride and sodium across epithelial cell membranes, leading to increased chloride in sweat. This test is crucial for diagnosing cystic fibrosis in suspected cases. Liver enzymes (Choice A), serum calcium (Choice B), and urine creatinine (Choice D) are not specific tests for cystic fibrosis and would not provide the necessary information for diagnosis in this case.

2. Which nonpharmacologic intervention appears to be effective in decreasing neonatal procedural pain?

• A. Tactile stimulation
• B. Commercial warm packs
• C. Doing procedure during infant sleep
• D. Oral sucrose and nonnutritive sucking

Correct answer: D

Rationale: Oral sucrose and nonnutritive sucking are effective nonpharmacologic interventions for reducing procedural pain in neonates.

3. The parents of a child with sickle cell anemia ask why their child did not have a sickle cell crisis until he was approximately 6 months old. How should the nurse respond?

• A. Your child probably had a crisis, and you were unaware of the symptoms.
• B. Are you sure your child has sickle cell anemia and not sickle cell trait?
• C. Affected children can be asymptomatic in early infancy because of high levels of fetal hemoglobin that inhibit sickling.
• D. Have you asked your doctor about this yet?

Correct answer: C

Rationale: The correct answer is C. Fetal hemoglobin (HbF) is present in high levels during early infancy, inhibiting sickling unlike adult hemoglobin (HbS). As the levels of HbF decrease and HbS increases, the risk of sickling and crises becomes more pronounced, typically after 6 months of age. Choice A is incorrect because it assumes the crisis went unnoticed, which is not supported by medical knowledge. Choice B is incorrect as it questions the child's diagnosis rather than explaining the phenomenon of delayed crises. Choice D is incorrect as it does not provide the parents with the necessary information regarding their query.

4. You are developing a plan of care for a hospitalized child. Which age group is most likely to view illness as a punishment for misdeeds?

• A. Adolescence
• B. Preschool age
• C. Infancy
• D. School age

Correct answer: B

Rationale: Preschool-aged children often engage in magical thinking, where they may believe that illness is a punishment for misdeeds. This belief is related to their cognitive development stage, where they may attribute cause and effect in a magical or unrealistic way. Adolescents are more likely to view illness as a disruption to their sense of independence or control. Infants lack the cognitive development to associate illness with punishment for misdeeds. School-aged children typically have a more concrete understanding of illness and its causes, moving away from magical thinking.

5. An adolescent with irritable bowel syndrome comes to see the school nurse. What information should the nurse share with the adolescent?

• A. A low-fiber diet is not always required.
• B. Stress management may be helpful.
• C. Milk products may or may not be a contributing factor.
• D. Pantoprazole (a proton pump inhibitor) is not a first-line treatment.

Correct answer: B

Rationale: The correct answer is B: Stress management may be helpful. Stress is known to exacerbate symptoms of irritable bowel syndrome (IBS), making stress management an essential part of managing the condition. While dietary modifications can also be beneficial, a low-fiber diet is not universally recommended for IBS, as fiber can be important for some individuals. Milk products may or may not be contributing factors, as food triggers can vary among individuals. Pantoprazole, a proton pump inhibitor, is not typically the first-line treatment for IBS, as it is more commonly used for conditions like gastroesophageal reflux disease.

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