Nursing Elites

1. Which nursing intervention is most important to assist in detecting hypopituitarism and hyperpituitarism in children?

• A. Carefully recording the height and weight of children to detect inappropriate growth.
• B. Performing head circumference measurements on infants under one year of age.
• C. Assessing for behavioral problems at home and school by interviewing the parents.
• D. Noting tracked weight gain without a gain in height on a growth chart.

Correct answer: A

Rationale: Recording the height and weight of children is crucial in detecting growth abnormalities like hypopituitarism and hyperpituitarism. Inappropriate growth patterns, such as disproportionate weight gain or stunted height, can be indicative of these conditions. Regular monitoring of height and weight is a fundamental nursing intervention that can aid in the early identification and management of pituitary-related disorders in children.

2. A 6 year old who has asthma is demonstrating a prolonged expiratory phase and wheezing and has a 35% of personal best peak expiratory flow rate (PEFR). Based on these findings, what actions should the nurse take first?

• A. Administer a prescribed bronchodilator.
• B. Encourage the child to cough and deep breath.
• C. Report findings to the health care provider.
• D. Determine what triggers precipitated this attack.

Correct answer: A

Rationale: Administering a bronchodilator will help open the airways and improve breathing.

3. What suggestion should the nurse provide to prevent diaper rash in a 4-month-old infant as requested by the mother?

• A. Generously powder the baby's diaper area with talcum powder at each diaper change to promote dryness.
• B. Wash the diaper area every 2 hours with soap and water to help prevent skin breakdown.
• C. Use a barrier cream, such as zinc oxide, which does not have to be completely removed with each diaper change.
• D. Place a cloth diaper inside the disposable diaper for overnight periods when increased wearing time is likely.

Correct answer: C

Rationale: Using a barrier cream like zinc oxide forms a protective layer on the skin, creating a barrier against irritants and moisture, thus helping to prevent diaper rash. Unlike other options, barrier creams do not need to be completely removed at each diaper change, allowing the skin to remain protected between changes.

4. A 3-year-old child is brought to the clinic by the parents who are concerned that the child is not yet potty trained. What is the nurse’s best response?

• A. Most children are potty trained by this age, so you should not be concerned
• B. Every child develops at their own pace. Let’s discuss some strategies to help
• C. Your child may need to be evaluated for developmental delays
• D. It’s best to force your child to use the potty to encourage training

Correct answer: B

Rationale: The correct answer is B because it is important to acknowledge that children develop at different rates. By offering support and discussing strategies for potty training, the nurse can provide the necessary guidance without causing unnecessary concern or pressure on the parents. Choice A is incorrect because it dismisses the parents' concerns. Choice C is incorrect because jumping to the conclusion of developmental delays without further assessment or discussion can cause undue anxiety. Choice D is incorrect because forcing a child to use the potty can lead to resistance and negative associations with potty training.

5. When caring for a 5-year-old child with a history of seizures who suddenly begins to have a tonic-clonic seizure, what should the nurse do first?

• A. Administer oxygen
• B. Insert an oral airway
• C. Turn the child to the side
• D. Start an IV line

Correct answer: C

Rationale: During a tonic-clonic seizure, the priority action is to turn the child to the side. This helps maintain an open airway and prevents aspiration of secretions or vomitus. It also helps in keeping the airway clear and promotes safety during the seizure episode. Administering oxygen, inserting an oral airway, and starting an IV line are important interventions but should follow the initial step of positioning the child to prevent airway obstruction.

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