Nursing Elites

1. Which laboratory value at the time of diagnosis should the nurse anticipate would determine the worst prognosis for a child with leukemia?

• A. Slow response to chemotherapy
• B. Platelets of 150,000/mcL
• C. Leukocytes less than 10,000/mcL
• D. Leukocytes of 275,000/mcL

Correct answer: D

Rationale: A high white blood cell count (leukocytes of 275,000/mcL) at diagnosis is associated with a worse prognosis in leukemia because it indicates a more aggressive disease with a higher tumor burden. Slow response to chemotherapy (choice A) is a consequence of the aggressive disease and not a determining factor at diagnosis. Platelets of 150,000/mcL (choice B) and leukocytes less than 10,000/mcL (choice C) are within normal ranges and not indicative of a worse prognosis in leukemia.

2. The nurse is caring for a patient from a culture unfamiliar to the local area. The best way for a culturally competent nurse to interact with the family is to:

• A. Explain that the child must now be cared for differently
• B. Speak in the language most used by the staff and encourage the family to learn it
• C. Be respectful and open-minded when discussing beliefs
• D. Insist that the family changes their beliefs

Correct answer: C

Rationale: The best way for a culturally competent nurse to interact with a family from an unfamiliar culture is to be respectful and open-minded when discussing beliefs. This approach demonstrates cultural competence by honoring and valuing the family's beliefs and practices. Choice A is incorrect as it disregards the family's cultural practices without understanding them. Choice B is not the best approach as it focuses on language rather than respecting beliefs. Choice D is inappropriate as it goes against the principles of cultural competence by imposing beliefs on the family.

3. What component should be included in the nutritional management of a child with Crohn's disease?

• A. High fiber
• B. Increased protein
• C. Reduced calories
• D. Herbal supplements

Correct answer: B

Rationale: The correct answer is B: Increased protein. Children with Crohn's disease require a diet high in protein to support growth and tissue repair. High fiber should be avoided as it can exacerbate symptoms of Crohn's disease. Reducing calories can lead to malnutrition, which is detrimental in this condition. Herbal supplements should be used cautiously and only under medical advice as they may interact with medications or worsen symptoms.

4. The nurse has just started assessing a young child who is febrile and appears ill. There is hyperextension of the child's head (opisthotonos) with pain on flexion. Which is the most appropriate action?

• A. Ask the parent when the neck was injured
• B. Refer for immediate medical evaluation
• C. Continue assessment to determine the cause of the neck pain
• D. Record head lag on the assessment record and continue the assessment of the child

Correct answer: B

Rationale: Opisthotonos with pain on flexion is a sign of possible meningitis or other serious neurological conditions, requiring immediate medical evaluation.

5. The Denver II is a test used to assess children. What does it evaluate?

• A. Behavior problems
• B. Developmental status
• C. Body mass index
• D. Infection likelihood

Correct answer: B

Rationale: The Denver II Developmental Screening Test is used to assess a child's development in four areas: personal-social, fine motor-adaptive, language, and gross motor skills. It helps identify children who may need further evaluation. Choice A, behavior problems, is incorrect as the Denver II primarily focuses on developmental milestones rather than behavior. Choice C, body mass index, is unrelated to the assessment of child development. Choice D, infection likelihood, is also not evaluated by the Denver II test.

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