Nursing Elites

1. How is the diagnosis of Hirschsprung disease confirmed in a 1-month-old infant admitted to the pediatric unit?

• A. Colonoscopy
• B. Rectal biopsy
• C. Multiple saline enemas
• D. Fiberoptic nasoenteric tube

Correct answer: B

Rationale: Rectal biopsy is the definitive diagnostic procedure for Hirschsprung disease in infants. It confirms the absence of ganglion cells in the affected bowel segment, which is characteristic of Hirschsprung disease. Colonoscopy (Choice A) is not typically used for confirmation as it may not provide a definitive result. Multiple saline enemas (Choice C) are utilized in the treatment of meconium ileus, a complication of cystic fibrosis, and not in the diagnosis of Hirschsprung disease. Fiberoptic nasoenteric tube (Choice D) is not a diagnostic tool for Hirschsprung disease; it is commonly used for gastrointestinal decompression or feeding purposes but does not confirm the diagnosis.

2. A parent brings a 2-month-old infant with Down syndrome to the pediatric clinic for a physical and administration of immunizations. Which clinical finding should alert the nurse to perform a further assessment?

• A. Flat occiput
• B. Small, low-set ears
• C. Circumoral cyanosis
• D. Protruding furrowed tongue

Correct answer: C

Rationale: Circumoral cyanosis should alert the nurse to perform further assessment in a 2-month-old infant with Down syndrome. This finding may indicate cardiac or respiratory issues, such as inadequate oxygenation. Small, low-set ears and a protruding furrowed tongue are common physical characteristics associated with Down syndrome and may not necessarily warrant immediate further assessment. A flat occiput is a normal variation in infant anatomy and is not typically a cause for immediate concern in this context.

3. A 7-year-old child with a diagnosis of type 1 diabetes mellitus is under the care of a nurse. What is the priority nursing intervention?

• A. Administering insulin as prescribed
• B. Monitoring blood glucose levels
• C. Teaching the child how to self-administer insulin
• D. Encouraging regular exercise

Correct answer: B

Rationale: The priority nursing intervention for a 7-year-old child with type 1 diabetes mellitus is monitoring blood glucose levels. This is crucial for managing and adjusting insulin therapy to maintain blood glucose within the target range. Administering insulin as prescribed is important but should be based on monitoring blood glucose levels. Teaching the child how to self-administer insulin may be appropriate for older children but may not be the priority for a 7-year-old. Encouraging regular exercise is a valuable aspect of diabetes management but is not the immediate priority over monitoring blood glucose levels.

4. A parent asks the nurse what they can do to help their child who is experiencing night terrors. What should the nurse suggest?

• A. Encourage the child to talk about the dream
• B. Establish a bedtime routine
• C. Allow the child to sleep with the parents
• D. Wake the child during the night

Correct answer: B

Rationale: Establishing a bedtime routine is the most appropriate suggestion for a child experiencing night terrors. Consistent bedtime routines help create a sense of security and predictability, reducing the likelihood of night terrors. Encouraging the child to talk about the dream (Choice A) may not be effective as night terrors occur during non-REM sleep, and the child may not remember the dreams. Allowing the child to sleep with the parents (Choice C) can reinforce dependency and may not address the underlying causes of night terrors. Waking the child during the night (Choice D) can disrupt their sleep cycle and worsen the occurrence of night terrors.

5. What behavior does a toddler subjected to prolonged hospitalization with limited parental visits typically exhibit?

• A. Engage in cheerful interactions with staff members
• B. Display indications of sadness throughout the day
• C. Experience excessive crying when parents are not present
• D. Show limited emotional response to the environment

Correct answer: D

Rationale: Toddlers subjected to prolonged hospitalization with limited parental visits usually exhibit a limited emotional response to the environment. This behavior can be a coping mechanism for the child in dealing with the separation from their primary caregivers. The child might not show the same level of engagement or emotional expression as they would if their parents were present. Choices A, B, and C are less likely because the child's emotional response is typically more subdued and withdrawn in such circumstances, rather than being cheerful, consistently sad, or excessively crying.

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