Nursing Elites

1. A 12-month-old infant has become immunosuppressed during a course of chemotherapy. When preparing the parents for the infant’s discharge, what information should the nurse give concerning the measles, mumps, and rubella (MMR) immunization?

• A. It should not be given until the infant reaches 2 years of age.
• B. Infants who are receiving chemotherapy should not be given these vaccines.
• C. It should be given to protect the infant from contracting any of these diseases.
• D. The parents should discuss this with their healthcare provider at the next visit.

Correct answer: B

Rationale: Live vaccines, like the measles, mumps, and rubella (MMR) vaccine, should not be administered to immunosuppressed infants, such as those undergoing chemotherapy. The weakened immune system of these infants may not be able to handle live vaccines safely, potentially leading to severe complications. Therefore, it is crucial to avoid giving live vaccines like MMR to infants receiving chemotherapy. Choice A is incorrect as delaying the MMR vaccine until the infant reaches 2 years of age is not the main concern in this scenario. Choice C is incorrect because although MMR vaccination is important for disease prevention, it should not be given to immunosuppressed infants. Choice D is incorrect as immediate action is needed to prevent potential harm from live vaccines in immunosuppressed infants.

2. The mother of a 5-year-old boy with a myelomeningocele who has developed a sensitivity to latex is being taught by the nurse. Which response from his mother indicates a need for further teaching?

• A. He needs to wear a medical alert identification.
• B. I will need to inform his caregivers about this.
• C. A product's label always indicates if it is latex-free.
• D. He should avoid all contact with latex.

Correct answer: C

Rationale: Choice C indicates a need for further teaching because not all products are clearly labeled as latex-free. It is essential for the mother to understand that she should not solely rely on product labels to determine latex content. She should be encouraged to verify with manufacturers and consult healthcare providers for accurate information. Choices A, B, and D are correct responses. Wearing a medical alert identification, informing caregivers, and ensuring the boy avoids all contact with latex are crucial steps in managing his sensitivity to latex and preventing potential allergic reactions.

3. A child is being assessed by a nurse for suspected nephrotic syndrome. What clinical manifestation is the nurse likely to observe?

• A. Jaundice
• B. Edema
• C. Hypertension
• D. Polyuria

Correct answer: B

Rationale: Edema is a hallmark clinical manifestation of nephrotic syndrome. In nephrotic syndrome, there is increased permeability of the glomerular filtration barrier, leading to protein loss in the urine (proteinuria). The decrease in serum protein levels results in a reduced oncotic pressure, leading to fluid shifting from the intravascular space into the interstitial spaces, causing edema. Jaundice (choice A) is not typically associated with nephrotic syndrome. Hypertension (choice C) is more commonly seen in conditions like nephritic syndrome. Polyuria (choice D) is excessive urination and is not a prominent feature of nephrotic syndrome.

4. 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.

5. A 6-year-old child with asthma is admitted to the hospital with an acute exacerbation. What is the priority nursing intervention?

• A. Administering a bronchodilator
• B. Administering an antihistamine
• C. Administering a corticosteroid
• D. Administering oxygen

Correct answer: A

Rationale: Administering a bronchodilator is the priority intervention for a child experiencing an acute asthma exacerbation. Bronchodilators help to dilate the airways quickly, providing immediate relief by opening up the narrowed air passages in asthma. Antihistamines are not the first-line treatment for asthma exacerbations and may not address the underlying bronchoconstriction. Corticosteroids are important for long-term control of asthma but may take longer to have an effect compared to bronchodilators. Administering oxygen is essential for hypoxemia in asthma exacerbations, but the priority is to relieve bronchoconstriction promptly with a bronchodilator.

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