Nursing Elites

1. Which pain assessment tool is most appropriate for a 3-month-old hospitalized with a fractured femur?

• A. FLACC scale
• B. Poker chip tool
• C. Number scale
• D. Visual analog scale

Correct answer: A

Rationale: The FLACC scale, which stands for Face, Legs, Activity, Cry, and Consolability, is specifically designed for nonverbal patients like infants and young children. It assesses pain based on observable behaviors such as facial expressions, leg movement, activity level, cry, and the ability to be consoled. In this case, a 3-month-old infant who is unable to communicate verbally would best be assessed using the FLACC scale to determine the level of pain experienced due to a fractured femur. The Poker chip tool, Number scale, and Visual analog scale are not suitable for nonverbal infants and young children as they rely on self-reporting or cognitive abilities that are not yet developed at this age.

2. A postpartum client is being discharged and asks the nurse when she should expect her menstrual period to return if she is not breastfeeding. The nurse's best response is:

• A. In about 6 to 8 weeks
• B. In about 3 to 4 months
• C. In about 6 months
• D. In about 1 year

Correct answer: A

Rationale: For non-breastfeeding mothers, the return of menstrual periods typically occurs around 6 to 8 weeks postpartum. This timeframe may vary among individuals, but generally, hormonal changes after childbirth lead to the resumption of menstrual cycles within this period.

3. The nurse is preparing new parents for discharge with their newborn. The father asks the nurse why the baby's head is so pointed and puffy-looking. What is the best response by the nurse?

• A. His head is molded from fitting through the birth canal. It will become more round.
• B. We refer to that as 'cone head,' which is a temporary condition that goes away.
• C. It might mean that your baby sustained brain damage during birth, and could have delays.
• D. I think he looks just like you. Your head is much the same shape as your baby's.

Correct answer: A

Rationale: The corrected response 'His head is molded from fitting through the birth canal. It will become more round.' is the best answer as it explains the physiological reason for the baby's appearance after birth. It reassures the father that the pointed and puffy-looking head is a normal part of the birthing process and will resolve on its own. Choice B is incorrect because while 'cone head' is a term used colloquially, it does not provide a detailed explanation. Choice C is incorrect and should be avoided as it introduces unnecessary worry by suggesting brain damage. Choice D is not an appropriate response as it doesn't address the father's concern or provide accurate information about newborn physiology.

4. When assessing a 5-year-old boy with major trauma, his blood pressure is 70/40 mm Hg, and his pulse rate is 140 beats/min and weak. The child's blood pressure:

• A. indicates decompensated shock.
• B. reflects adequate compensation.
• C. suggests increased intracranial pressure.
• D. is appropriate based on his age.

Correct answer: A

Rationale: In a 5-year-old boy with major trauma, a blood pressure of 70/40 mm Hg and a pulse rate of 140 beats/min, and weak, indicate decompensated shock. This presentation signifies inadequate perfusion, leading to compensatory mechanisms being overwhelmed, resulting in decompensated shock. Choice B is incorrect as the vital signs suggest the body is unable to adequately compensate for the trauma. Choice C is incorrect as the vital signs are more indicative of shock rather than increased intracranial pressure. Choice D is incorrect as such low blood pressure is not appropriate for a child of this age and indicates a critical condition.

5. A 5-year-old boy was struck by a car when he ran out into the street. When you arrive at the scene and approach the child, you see him lying supine approximately 15 feet from the car. Based on the child's age and mechanism of injury, which of the following should you suspect to be his PRIMARY injury?

• A. Lower leg injury
• B. Head injury
• C. Upper thorax injury
• D. Pelvic injury

Correct answer: D

Rationale: Given the mechanism of injury and the distance the child was thrown, a primary pelvic injury should be suspected due to the high impact and force. The pelvis is a common site for significant injury in such cases, and the distance the child was thrown indicates a high-energy impact that could lead to pelvic fractures or injuries.

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