Nursing Elites

1. When reinforcing teaching with the parents of a 7-year-old child with attention-deficit/hyperactivity disorder (ADHD) about the child's medication, which statement by the parents indicates an understanding of the medication's side effects?

• A. We should monitor our child's growth and appetite regularly.
• B. The medication may cause drowsiness, so we will give it at bedtime.
• C. We need to give the medication with food to avoid stomach upset.
• D. The medication can cause increased urination, so fluid intake should be limited.

Correct answer: A

Rationale: The correct answer is A: 'We should monitor our child's growth and appetite regularly.' Correct monitoring of the child's growth and appetite is crucial when a child is on ADHD medications, especially stimulants, as these medications can have side effects related to growth and appetite. Monitoring these parameters regularly helps in assessing the medication's impact and making any necessary adjustments. Choices B, C, and D are incorrect: B talks about drowsiness, C mentions avoiding stomach upset, and D refers to increased urination and limiting fluid intake. While these are potential side effects of medications, they do not directly address the importance of monitoring growth and appetite, which is crucial in children on ADHD medications.

2. Which developmental behavior should the practical nurse identify as normal for a 6-month-old infant?

• A. Rolls over completely.
• B. Creeps on all fours.
• C. Pulls self to a standing position.
• D. Assumes a sitting position independently.

Correct answer: A

Rationale: The correct answer is A: 'Rolls over completely.' By 6 months of age, infants typically achieve the milestone of rolling over completely. This ability demonstrates increasing strength and coordination. Creeping on all fours, pulling self to a standing position, and assuming a sitting position independently are skills that are usually developed at later stages of infancy. Creeping usually occurs around 9-10 months, pulling self to a standing position around 9-12 months, and assuming a sitting position independently around 8 months. Therefore, at 6 months, rolling over completely is the most expected developmental behavior.

3. During a well-baby check of a 7-month-old infant, the practical nurse notes an absence of babbling. Which focused assessment should the PN implement?

• A. Visual function.
• B. Auditory function.
• C. Cognitive function.
• D. Social development.

Correct answer: B

Rationale: The absence of babbling in a 7-month-old infant is a concerning auditory development milestone. Babbling is an early stage of language development that involves making various sounds. A lack of babbling could indicate a hearing impairment or other auditory issues. Therefore, the practical nurse should focus on assessing the infant's auditory function to determine if further evaluation or intervention is necessary. Choices A, C, and D are incorrect because the absence of babbling specifically points towards a potential issue related to auditory function rather than visual, cognitive, or social development.

4. A 3-year-old with HIV infection is staying with a foster family who is caring for 3 other foster children in their home. When one of the children acquires pertussis, the foster mother calls the clinic and asks the nurse what she should do. Which action should the nurse take first?

• A. Remove the child who has HIV from the foster home.
• B. Report the exposure of the child with HIV to the health department.
• C. Place the child who has HIV in reverse isolation.
• D. Review the immunization documentation of the child who has HIV.

Correct answer: D

Rationale: The priority action for the nurse is to review the immunization documentation of the child with HIV to ensure they have received the necessary vaccines. This step is crucial in protecting the child's health and preventing further complications from vaccine-preventable diseases like pertussis. By reviewing the immunization documentation first, the nurse can determine the child's protection against pertussis and other infectious diseases. Removing the child from the foster home (Choice A) may not be necessary if the child is adequately vaccinated. Reporting the exposure to the health department (Choice B) and placing the child in reverse isolation (Choice C) are important steps but reviewing the immunization status takes precedence to assess the child's protection and guide further actions.

5. The parents of a 3-year-old boy who has Duchenne muscular dystrophy (DMD) ask, 'how can our son have this disease? We are wondering if we should have any more children.' What information should the nurse provide these parents?

• A. This is an inherited X-linked recessive disorder, which primarily affects male children in the family.
• B. The male infant had a viral infection that went unnoticed and untreated, leading to muscle damage.
• C. The lack of the protein dystrophin in the mother can impact the muscle groups of males.
• D. Damage to the spinal cord due to birth trauma from a breech vaginal birth weakens the muscles.

Correct answer: A

Rationale: The nurse should inform the parents that Duchenne muscular dystrophy is an X-linked recessive disorder, which primarily affects male children in the family. This genetic condition is caused by a mutation in the dystrophin gene located on the X chromosome. Females are usually carriers of the gene mutation and may pass it on to their sons. Daughters of carrier mothers have a 50% chance of being carriers themselves. Understanding the genetics of DMD can help the parents make informed decisions about family planning and genetic counseling.

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