Nursing Elites

1. Which of the following findings would indicate altered mental status in a small child?

• A. Recognizing the parents
• B. Showing fright at the EMT-B's presence
• C. Displaying a lack of attention to the EMT-B's presence
• D. Maintaining consistent eye contact with the EMT-B

Correct answer: C

Rationale: In a small child, displaying a lack of attention to the EMT-B's presence would indicate altered mental status. This behavior suggests a diminished level of consciousness or awareness, which is concerning. Recognizing the parents (Choice A) is a normal and expected behavior for a child. Showing fright at the EMT-B's presence (Choice B) may indicate fear or anxiety but not necessarily altered mental status. Maintaining consistent eye contact with the EMT-B (Choice D) may indicate engagement or curiosity rather than altered mental status.

2. When teaching the parents of a child with a diagnosis of type 1 diabetes mellitus about insulin administration, what should the nurse emphasize?

• A. Rotate injection sites
• B. Administer insulin before meals
• C. Store insulin in the refrigerator
• D. Administer insulin at bedtime

Correct answer: A

Rationale: The correct answer is to rotate injection sites. This practice helps prevent lipodystrophy, a localized loss of fat tissue that can affect insulin absorption. By rotating sites, the child can avoid developing lumps or indentations in the skin where insulin is repeatedly injected. Administering insulin before meals (choice B) may be necessary for certain types of insulin but is not the priority when teaching about insulin administration. Storing insulin in the refrigerator (choice C) is important for maintaining its potency, but it is not the primary emphasis when teaching about insulin administration. Administering insulin at bedtime (choice D) may be necessary based on the child's insulin regimen but is not the primary consideration for teaching injection techniques and site rotation.

3. A 2-week-old infant is admitted with a tentative diagnosis of a ventricular septal defect. The parents report that their baby has had difficulty feeding since coming home after birth. What should the nurse consider before responding?

• A. Feeding problems are common in neonates.
• B. Inadequate sucking is not significant in the absence of cyanosis.
• C. Ineffective sucking and swallowing may be early indications of a heart defect.
• D. Many neonates retain mucus, which may interfere with feeding for several weeks.

Correct answer: C

Rationale: In this scenario, the nurse should consider that ineffective sucking and swallowing in a 2-week-old infant could be early signs of a heart defect such as a ventricular septal defect. This is crucial information as it can guide further assessment and management. Choice A is incorrect because while feeding problems can be common in neonates, in this case, the specific context of a suspected heart defect should be prioritized. Choice B is incorrect as inadequate sucking can indeed be significant, especially when considering potential underlying heart issues, regardless of the presence of cyanosis. Choice D is incorrect as while mucus retention can affect feeding, in this case, the focus should be on the possibility of a heart defect rather than a temporary issue like mucus interference.

4. Which is the most appropriate nursing diagnosis for a child with acute glomerulonephritis?

• A. Risk for injury related to malignant process and treatment
• B. Fluid volume deficit related to excessive losses
• C. Fluid volume excess related to decreased plasma filtration
• D. Fluid volume excess related to fluid accumulation in tissues and third spaces

Correct answer: C

Rationale: The most appropriate nursing diagnosis for a child with acute glomerulonephritis is 'Fluid volume excess related to decreased plasma filtration.' Acute glomerulonephritis is characterized by inflammation in the glomeruli, leading to decreased plasma filtration and retention of fluid. This results in fluid volume excess rather than deficit, making choice C the correct answer. Choice A is incorrect because acute glomerulonephritis is not primarily associated with a malignant process. Choice B is incorrect as the condition typically presents with fluid volume excess rather than deficit. Choice D is also incorrect as fluid accumulation in tissues and third spaces is not a typical manifestation of acute glomerulonephritis.

5. When caring for a child diagnosed with asthma, what is an important nursing intervention?

• A. Administering bronchodilators
• B. Encouraging physical activity
• C. Monitoring oxygen saturation
• D. Providing nutritional support

Correct answer: A

Rationale: Administering bronchodilators is a crucial nursing intervention for a child with asthma as it helps to open the airways and improve breathing. Bronchodilators work by relaxing the muscles around the airways, making breathing easier for the child. Encouraging physical activity may exacerbate asthma symptoms in some cases, so it is not recommended as a primary intervention. Monitoring oxygen saturation is important in assessing respiratory status, but administering bronchodilators would take precedence in this situation. Providing nutritional support is a general nursing intervention and not specific to managing asthma symptoms.

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