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. The nurse is caring for a 14-year-old adolescent who was admitted to the hospital after a suicide attempt. The adolescent’s mood appears stable, and the healthcare provider has recommended discharge. What is the nurse’s priority action?

• A. Ensure that a safety plan is in place before discharge
• B. Provide education about medication adherence
• C. Encourage the adolescent to participate in group therapy
• D. Schedule a follow-up appointment with a mental health professional

Correct answer: A

Rationale: The priority action for the nurse is to ensure that a safety plan is in place before discharge. A safety plan is essential to assist the adolescent in managing future crises and decreasing the likelihood of another suicide attempt. It provides guidance on coping strategies and resources to help the adolescent stay safe in times of distress.

3. The nurse is assessing a 4-year-old child who is brought to the clinic for a routine checkup. The child’s parent reports that the child has been more irritable and less active over the past week. The nurse notes a petechial rash on the child’s trunk and extremities. What should the nurse do first?

• A. Ask the parent about recent exposure to contagious diseases
• B. Review the child’s immunization record
• C. Measure the child’s temperature
• D. Notify the healthcare provider immediately

Correct answer: D

Rationale: In this scenario, the child's presentation with irritability, decreased activity, and a petechial rash raises concern for a serious condition like meningitis. Petechial rash can be indicative of meningitis or other critical illnesses. Therefore, the nurse's priority should be to notify the healthcare provider immediately to ensure prompt evaluation and appropriate management. Asking about recent exposure to contagious diseases may be relevant later but is not the most urgent action. Reviewing the child's immunization record and measuring the temperature can provide valuable information but should not take precedence over the need to address the potential serious condition indicated by the petechial rash.

4. The nurse is measuring the frontal occipital circumference (FOC) of a 3-month-old infant and notes that the FOC has increased by 5 inches since birth, and the child's head appears large in relation to body size. Which action is most important for the nurse to take next?

• A. Measure the infant's head-to-toe length.
• B. Palpate the anterior fontanel for tension and bulging.
• C. Observe the infant for sunken eyes.
• D. Plot the measurement on the infant's growth chart.

Correct answer: B

Rationale: Palpating the anterior fontanel for tension and bulging is crucial in assessing for increased intracranial pressure. In this scenario, the infant's large head size and rapid increase in the frontal occipital circumference raise concerns for potential issues such as hydrocephalus. Measuring the head-to-toe length (Choice A) is not the priority when assessing for increased intracranial pressure. Observing for sunken eyes (Choice C) is more indicative of dehydration rather than increased intracranial pressure. While plotting the measurement on the infant's growth chart (Choice D) is important for tracking growth, it does not address the immediate concern of assessing for increased intracranial pressure.

5. The healthcare provider is caring for a 3-year-old child who is hospitalized with dehydration. The child is now receiving IV fluids and has started to produce urine. What is the best indicator that the child’s dehydration is improving?

• A. The child’s urine output has increased
• B. The child’s skin turgor is normal
• C. The child’s weight has increased
• D. The child’s vital signs are stable

Correct answer: A

Rationale: An increase in urine output is a reliable indicator that the child's hydration status is improving. Adequate urine output signifies that the kidneys are functioning properly and that the body is effectively eliminating waste and excess fluids, indicating improved hydration levels. The other options are not as direct indicators of hydration status. Skin turgor and weight changes can be influenced by various factors, and stable vital signs do not specifically reflect hydration status.

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