Nursing Elites

1. A 12-year-old girl has recently begun menstruating and is well into puberty. The child is visiting the health care provider today for a routine physical examination. Which finding should cause concern in the nurse?

• A. Breasts of slightly different sizes
• B. Irregular periods
• C. Vulvar irritation
• D. Supernumerary nipple

Correct answer: C

Rationale: Vulvar irritation may indicate an infection or other issues and should be further evaluated. In a pubescent girl, breasts of slightly different sizes and irregular periods are common variations of normal development. Supernumerary nipple, an extra nipple, is a benign condition that is not typically concerning during puberty.

2. What is the most frequent cause of hypovolemic shock in children?

• A. Sepsis
• B. Blood loss
• C. Anaphylaxis
• D. Heart failure

Correct answer: B

Rationale: Hypovolemic shock in children is most frequently caused by blood loss, which can result from trauma, surgery, or gastrointestinal bleeding. Sepsis and anaphylaxis can lead to different types of shock (septic and anaphylactic), and heart failure is related to cardiogenic shock.

3. Why are neonates predisposed to problems with thermoregulation?

• A. Renal function is not fully developed
• B. Flexed posture favors heat loss
• C. A large body surface area favors heat loss to the environment
• D. A thick layer of subcutaneous fat provides excellent insulation

Correct answer: C

Rationale: Newborns have a large surface area relative to their body weight, making them more susceptible to heat loss and requiring careful thermoregulation. Choice A is incorrect because renal function is not directly related to thermoregulation. Choice B is incorrect because a flexed posture actually helps reduce heat loss by minimizing the surface area exposed to the environment. Choice D is incorrect because neonates have limited subcutaneous fat, which contributes to their susceptibility to heat loss.

4. The nurse is admitting a child with severe isotonic dehydration. Which intravenous fluid should the nurse anticipate the doctor to order initially to replace fluids?

• A. 0.9% normal saline
• B. D5 0.2% (1/4) normal saline
• C. D5W
• D. Albumin

Correct answer: A

Rationale: In the case of severe isotonic dehydration, the initial fluid of choice is 0.9% normal saline. This solution is preferred because it helps to restore both fluids and electrolytes effectively. Options B, C, and D are not suitable for the initial management of severe isotonic dehydration. D5 0.2% (1/4) normal saline (Choice B) is a hypotonic solution and might worsen the imbalance. D5W (Choice C) is a hypotonic solution that does not contain electrolytes essential for rehydration. Albumin (Choice D) is a colloid solution used for specific indications like hypoproteinemia or hypoalbuminemia, not for initial rehydration in severe dehydration.

5. A preschool-age boy presents to the outpatient clinic for a sore throat. In the child’s mind, which is the most likely cause for the sore throat?

• A. Being exposed to a classmate with strep throat
• B. Not eating the right foods
• C. Not taking daily vitamins
• D. Yelling at sibling for being annoying

Correct answer: D

Rationale: The correct answer is D. Preschool-age children often attribute illness to their actions, like yelling at a sibling or not following instructions. They may not understand medical causes such as exposure to infections like strep throat (choice A), dietary factors (choice B), or vitamin deficiencies (choice C). It is common for young children to connect symptoms to recent behaviors or events within their limited understanding.

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