Nursing Elites

1. A 12-year-old child is admitted to the hospital with a diagnosis of osteomyelitis. Which finding should the nurse expect during the assessment?

• A. Localized pain and swelling
• B. Generalized joint stiffness
• C. Pain in the muscles
• D. Limited range of motion in the limbs

Correct answer: A

Rationale: In osteomyelitis, an infection of the bone, patients typically present with localized pain, swelling, and warmth over the affected bone. This is due to the inflammatory response in the bone tissue. Generalized joint stiffness, pain in the muscles, and limited range of motion in the limbs are not specific to osteomyelitis and are more commonly associated with other conditions.

2. A male adolescent who is newly diagnosed with a seizure disorder receives a prescription for an anticonvulsant. Which statement indicates the client is at risk for non-compliance with life-long medication management?

• A. I hope I will be able to drive while taking these pills.
• B. My friends will think I am a freak if I take these pills.
• C. I don't want my parents monitoring my medications.
• D. I will take the pills at home so others will not see me.

Correct answer: B

Rationale: The statement 'My friends will think I am a freak if I take these pills' indicates concerns about peer perception, which can lead to non-compliance in adolescents. Peer pressure and fear of social stigma can significantly impact medication adherence in this age group. Option B is the most concerning response as it reflects the client's worry about how others perceive him for taking medication, potentially leading to non-compliance due to social pressures. Choices A, C, and D do not directly address societal perception or peer pressure, making them less likely to impact the client's medication adherence negatively.

3. A 15-year-old adolescent with anorexia nervosa is admitted to the hospital for severe weight loss. The nurse notes that the client has dry skin, brittle hair, and is severely underweight. What is the nurse’s priority intervention?

• A. Establish a therapeutic relationship with the client
• B. Monitor the client’s vital signs frequently
• C. Initiate a structured eating plan
• D. Provide education about healthy eating habits

Correct answer: C

Rationale: In this scenario, the priority intervention for the nurse is to initiate a structured eating plan. Anorexia nervosa is a serious eating disorder characterized by severe food restriction, which can lead to malnutrition and severe weight loss. By starting a structured eating plan, the nurse can ensure the client receives the necessary nutrition to begin the process of weight restoration and recovery. Monitoring vital signs is essential, but without addressing the nutrition deficiency, vital signs may not improve significantly. Establishing a therapeutic relationship is crucial for long-term care but may not address the immediate risk of malnutrition. Providing education about healthy eating habits is important but may not be effective initially due to the severity of the client's condition.

4. When assessing a child with suspected meningitis, which finding is a characteristic sign of meningitis?

• A. High-pitched cry
• B. Tachycardia
• C. Photophobia
• D. Hypotension

Correct answer: C

Rationale: Photophobia, which is sensitivity to light, is a characteristic sign of meningitis in children. It commonly presents along with symptoms such as headache and neck stiffness. This symptom is important to recognize early for prompt diagnosis and treatment of meningitis.

5. The heart rate for a 3-year-old with a congenital heart defect has steadily decreased over the last few hours, now it's 76 bpm, the previous reading 4 hours ago was 110 bpm. Which additional finding should be reported immediately to a healthcare provider?

• A. Oxygen saturation 94%.
• B. RR of 25 breaths/minute.
• C. Urine output 20 mL/hr.
• D. BP 70/40.

Correct answer: D

Rationale: A significant drop in heart rate and blood pressure should be reported immediately as it may indicate worsening of the congenital heart defect. A decrease in blood pressure may suggest poor cardiac output and compromised perfusion, requiring urgent medical attention. The other findings (oxygen saturation of 94%, RR of 25 breaths/minute, and urine output of 20 mL/hr) are within normal ranges for a 3-year-old and do not indicate immediate deterioration of the heart defect.

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