Nursing Elites

1. A 3-year-old child with a history of frequent respiratory infections is being evaluated for cystic fibrosis. What diagnostic test should the nurse anticipate will be ordered?

• A. Chest X-ray
• B. Sweat chloride test
• C. Pulmonary function test
• D. Sputum culture

Correct answer: B

Rationale: The sweat chloride test is the gold standard diagnostic test for cystic fibrosis as it measures the concentration of chloride in sweat. In cystic fibrosis, there is an abnormal transport of chloride across epithelial membranes, leading to elevated sweat chloride levels. A chest X-ray may show characteristic changes in the lungs associated with cystic fibrosis, but it is not a definitive diagnostic test. Pulmonary function tests assess lung function but do not specifically diagnose cystic fibrosis. Sputum culture may identify respiratory infections but does not confirm the diagnosis of cystic fibrosis.

2. The nurse is assessing a child with a possible fracture. What would the nurse identify as the most reliable indicator?

• A. Lack of spontaneous movement
• B. Point tenderness
• C. Bruising
• D. Inability to bear weight

Correct answer: B

Rationale: Point tenderness is the most reliable indicator of a possible fracture in a child. It is a localized tenderness experienced when pressure is applied to a specific area, suggesting a potential fracture. This tenderness is considered more specific to a fracture than other symptoms such as lack of spontaneous movement, bruising, or inability to bear weight. Lack of spontaneous movement and inability to bear weight can be present in various musculoskeletal injuries, while bruising may not always be immediate or specific to a fracture.

3. What behavior is essential for preventing in a child postoperatively after undergoing heart surgery to repair defects associated with tetralogy of Fallot?

• A. Crying
• B. Coughing
• C. Straining at stool
• D. Unnecessary movement

Correct answer: C

Rationale: Preventing straining at stool is crucial postoperatively after heart surgery for tetralogy of Fallot to avoid increasing intrathoracic pressure and placing stress on the surgical site. This can help prevent complications and promote faster healing. While crying, coughing, and unnecessary movement are common postoperative behaviors, they are not specifically linked to worsening outcomes in this context. Straining at stool is particularly emphasized due to its potential to impact the surgical site and overall recovery process.

4. During a routine monthly examination, a 5-month-old infant is brought to the pediatric clinic. What assessment finding should alert the nurse to notify the health care provider?

• A. Temperature of 99.5°F
• B. Blood pressure of 75/48 mm Hg
• C. Heart rate of 100 beats per minute
• D. Respiratory rate of 50 breaths per minute

Correct answer: D

Rationale: A respiratory rate of 50 breaths per minute in a 5-month-old infant is considered high and may indicate respiratory distress. Infants normally have a higher respiratory rate than older children and adults, but a rate of 50 breaths per minute is above the expected range. This finding warrants immediate attention as it may be indicative of an underlying respiratory issue or distress. Choice A (Temperature of 99.5°F) is within the normal range for body temperature and does not necessarily indicate a critical issue. Choice B (Blood pressure of 75/48 mm Hg) is not typically assessed in isolation for a 5-month-old infant during a routine examination, and the values provided are not indicative of a critical condition. Choice C (Heart rate of 100 beats per minute) is within the normal range for heart rate in infants and may not be a cause for immediate concern during a routine examination.

5. Which of the following parameters would be LEAST reliable when assessing the perfusion status of a 2-year-old child with possible shock?

• A. distal capillary refill
• B. systolic blood pressure
• C. skin color and temperature
• D. presence of peripheral pulses

Correct answer: B

Rationale: Systolic blood pressure is the least reliable parameter when assessing the perfusion status of a 2-year-old child with possible shock. In pediatric patients, especially young children, blood pressure may not decrease until significant shock has already occurred, making it a late indicator of inadequate perfusion. Depending solely on systolic blood pressure to evaluate perfusion status in this age group can lead to a delay in appropriate interventions. Distal capillary refill time, skin color, and temperature changes, and the presence of peripheral pulses are more sensitive and early indicators of perfusion status in pediatric patients. Monitoring distal capillary refill provides information on peripheral perfusion, while changes in skin color and temperature can signal circulatory compromise. Evaluating the presence or absence of peripheral pulses offers insights into vascular perfusion. These parameters offer more reliable and prompt feedback on a child's perfusion status compared to systolic blood pressure.

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