Nursing Elites

1. A child is brought to the clinic after tripping over a rock. The child states, 'I twisted my ankle,' and is given a diagnosis of a sprain. What intervention is most important for the nurse to include in the discharge instructions for this child?

• A. For the first 24 hours, apply ice for 20 minutes and then remove for 60 minutes.
• B. Bed rest with the leg elevated for 36 hours.
• C. May take an NSAID for pain as needed.
• D. Use a compression dressing for 72 hours.

Correct answer: A

Rationale: The correct intervention for a sprained ankle is to apply ice for 20 minutes every hour for the first 24 hours, then remove for 60 minutes to prevent tissue damage. This regimen helps reduce swelling and pain. Bed rest with the leg elevated for an extended period (36 hours) may lead to stiffness and decreased range of motion. While NSAIDs can be used for pain, they may not be necessary if pain is manageable with ice and rest. Using a compression dressing for 72 hours continuously may impede proper circulation and delay healing by restricting blood flow.

2. A home care nurse is visiting a family for the first time. The 4-week-old infant had surgery for exstrophy of the bladder and creation of an ileal conduit soon after birth. When the nurse arrives, the mother appears tired, and the baby is crying. After an introduction, which is the most appropriate statement by the nurse?

• A. “Tell me about your daily routine.”
• B. “You look tired. Is everything alright?”
• C. “When was the last time the baby had a bottle?”
• D. “Oh, it looks like you two are having a bad day.”

Correct answer: A

Rationale: Asking about the daily routine is the most appropriate statement by the nurse in this scenario. It allows the nurse to gather important information about the family's schedule, feeding patterns, and overall care routine for the infant. This open-ended question helps the nurse assess the family's situation comprehensively and identify any areas where support may be needed. Choices B, C, and D are less appropriate as they do not focus on gathering relevant information about the family's routine and needs but rather make assumptions or ask about specific isolated events.

3. An 8-year-old child with the diagnosis of meningitis is to have a lumbar puncture. What should the nurse explain is the purpose of this procedure?

• A. To measure the pressure of cerebrospinal fluid
• B. To obtain a sample of cerebrospinal fluid for analysis
• C. To relieve intracranial pressure
• D. To assess the presence of infection in the spinal fluid

Correct answer: B

Rationale: The primary purpose of a lumbar puncture is to obtain a sample of cerebrospinal fluid for analysis. This sample helps in diagnosing conditions such as meningitis by evaluating the presence of pathogens or abnormalities in the cerebrospinal fluid. Measuring the pressure of cerebrospinal fluid (Choice A) is not the main objective of a lumbar puncture, although it can be done during the procedure. Relieving intracranial pressure (Choice C) is not the direct purpose of a lumbar puncture, as other interventions are typically used for this purpose. Assessing the presence of infection in the spinal fluid (Choice D) is related to the overall goal of obtaining a sample for analysis, making it a secondary outcome of the procedure.

4. How is the diagnosis of Hirschsprung disease confirmed in a 1-month-old infant admitted to the pediatric unit?

• A. Colonoscopy
• B. Rectal biopsy
• C. Multiple saline enemas
• D. Fiberoptic nasoenteric tube

Correct answer: B

Rationale: Rectal biopsy is the definitive diagnostic procedure for Hirschsprung disease in infants. It confirms the absence of ganglion cells in the affected bowel segment, which is characteristic of Hirschsprung disease. Colonoscopy (Choice A) is not typically used for confirmation as it may not provide a definitive result. Multiple saline enemas (Choice C) are utilized in the treatment of meconium ileus, a complication of cystic fibrosis, and not in the diagnosis of Hirschsprung disease. Fiberoptic nasoenteric tube (Choice D) is not a diagnostic tool for Hirschsprung disease; it is commonly used for gastrointestinal decompression or feeding purposes but does not confirm the diagnosis.

5. A child with a diagnosis of asthma is being evaluated for medication management. What is an important assessment for the nurse to perform?

• A. Assess the child's sleep patterns
• B. Assess the child's dietary intake
• C. Assess the child's academic performance
• D. Assess the child's behavior at home

Correct answer: B

Rationale: Assessing the child's dietary intake is crucial in managing asthma as certain foods can trigger or worsen symptoms. Monitoring dietary habits helps identify any potential triggers and ensures proper nutrition, which can impact asthma control. Assessing sleep patterns, academic performance, or behavior at home may provide valuable information in a general health assessment, but when specifically managing asthma, dietary intake assessment is the most relevant.

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