Nursing Elites

1. A 1-year-old child has a congenital cardiac malformation that causes right-to-left shunting of blood through the heart. What clinical finding should the healthcare provider expect?

• A. Proteinuria
• B. Peripheral edema
• C. Elevated hematocrit
• D. Absence of pedal pulses

Correct answer: C

Rationale: In a congenital cardiac malformation causing right-to-left shunting, the nurse should expect an elevated hematocrit. This occurs because the body compensates for decreased oxygenation by producing more red blood cells. Proteinuria (Choice A) is not typically associated with congenital cardiac malformations causing right-to-left shunting. Peripheral edema (Choice B) is more commonly seen in conditions causing left-sided heart failure. Absence of pedal pulses (Choice D) is not a typical finding in congenital cardiac malformations causing right-to-left shunting.

2. A group of students is reviewing information about the endocrine system in infants and children. The students demonstrate understanding of the information when they state:

• A. Endocrine glands begin developing in the first trimester of gestation.
• B. At birth, the endocrine glands are not fully functional.
• C. Infants may have difficulty balancing glucose and electrolytes.
• D. A child’s endocrine system plays a vital role in growth and development.

Correct answer: C

Rationale: The correct statement is that infants may have difficulty balancing glucose and electrolytes because their endocrine systems are immature. Newborns have developing endocrine glands that are not yet fully functional, leading to challenges in maintaining glucose and electrolyte balance. Choice A is incorrect as endocrine glands start developing in the first trimester, not the third trimester. Choice B is incorrect as endocrine glands are not fully functional at birth. Choice D is incorrect because while a child’s endocrine system indeed plays a vital role in growth and development, the specific focus of the question is on the challenges infants face due to immature endocrine glands.

3. What is important to include in discharge instructions for a child who has had a tonsillectomy?

• A. Encourage the child to gargle with salt water
• B. Encourage fluid intake
• C. Provide the child with hard candy
• D. Apply heat to the neck

Correct answer: B

Rationale: Encouraging fluid intake is essential post-tonsillectomy to keep the throat moist, aid in healing, and prevent dehydration. Gargling with salt water may irritate the surgical site and is typically avoided to prevent discomfort and irritation. Providing hard candy can be harmful as it may cause trauma to the surgical area and should be avoided to prevent injury. Applying heat to the neck is not recommended as it can increase swelling and discomfort in the surgical region. Therefore, the correct instruction is to encourage fluid intake.

4. What clinical manifestation of tetralogy of Fallot should the nurse expect when caring for children with this diagnosis?

• A. Slow respirations
• B. Clubbing of fingers
• C. Decreased RBC counts
• D. Subcutaneous hemorrhages

Correct answer: B

Rationale: Clubbing of fingers is a common manifestation in children with tetralogy of Fallot due to chronic hypoxia. Clubbing occurs as a result of long-standing decreased oxygen levels in the blood, leading to changes in the fingertips. Slow respirations (Choice A) are not typically a direct clinical manifestation of tetralogy of Fallot. While decreased RBC counts (Choice C) may occur due to chronic hypoxia, they are not a primary manifestation specific to tetralogy of Fallot. Subcutaneous hemorrhages (Choice D) are not a common clinical manifestation associated with tetralogy of Fallot.

5. A 3-year-old child ingests a substance that may be a poison. The parent calls a neighbor who is a nurse and asks what to do. What should the nurse recommend the parent do?

• A. Administer syrup of ipecac.
• B. Call the poison control center.
• C. Take the child to the emergency department.
• D. Give the child bread dipped in milk to absorb the poison.

Correct answer: B

Rationale: In cases of potential poisoning, the best immediate action to take is to call the poison control center. Administering syrup of ipecac is no longer recommended as it can lead to complications such as aspiration and may interfere with subsequent treatments. Taking the child to the emergency department should only be done if advised by the poison control center or if the child is showing severe symptoms. Giving bread dipped in milk to absorb the poison is not an appropriate or effective treatment for poisoning, as it does not address the toxicity of the ingested substance and may delay appropriate medical interventions.

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