Nursing Elites

1. When evaluating a child with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) 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 as certain foods and additives can affect ADHD symptoms. Ensuring a balanced diet can help manage symptoms and provide proper nutrition. Assessing sleep patterns (Choice A) is also important, but dietary intake is more directly linked to symptom management in ADHD. Academic performance (Choice C) and behavior at home (Choice D) may be affected by ADHD but are not as directly related to medication management as dietary intake.

2. What are the most common signs and symptoms of leukemia related to bone marrow involvement?

• A. petechiae, infection, fatigue
• B. headache, papilledema, irritability
• C. muscle wasting, weight loss, fatigue
• D. decreased intracranial pressure, psychosis, confusion

Correct answer: A

Rationale: The correct answer is A: petechiae, infection, fatigue. In leukemia, bone marrow involvement leads to a decrease in normal blood cell production, resulting in petechiae (small red or purple spots on the skin), increased susceptibility to infections due to decreased white blood cells, and fatigue from anemia. Choices B, C, and D are incorrect because they do not directly relate to the typical signs and symptoms of leukemia with bone marrow involvement. Headache, papilledema, irritability, muscle wasting, weight loss, decreased intracranial pressure, psychosis, and confusion are not typically associated with leukemia and bone marrow involvement.

3. A nurse is teaching a class about immunizations to members of a grammar school’s Parent-Teachers Association. Which childhood disease is the nurse discussing when explaining that it is a viral disease that starts with malaise and a highly pruritic rash that begins on the abdomen, spreads to the face and proximal extremities, and can result in grave complications?

• A. Rubella
• B. Rubeola
• C. Chickenpox
• D. Scarlet fever

Correct answer: C

Rationale: The correct answer is C, Chickenpox (varicella). Chickenpox is a viral disease characterized by a highly pruritic rash that typically starts on the abdomen and then spreads to other parts of the body, including the face and proximal extremities. It can lead to complications such as pneumonia and encephalitis. Rubella (German measles) presents with a mild rash and swollen lymph nodes; Rubeola (measles) also presents with a rash but starts on the face before spreading downwards; Scarlet fever is caused by Group A Streptococcus bacteria and is characterized by a rash, fever, and sore throat.

4. What is the typical therapeutic management treatment for children with Hirschsprung disease?

• A. Daily enemas
• B. Low-fiber diet
• C. Permanent colostomy
• D. Surgical removal of affected section of bowel

Correct answer: D

Rationale: The most common treatment for Hirschsprung disease is the surgical removal of the affected section of the bowel. This procedure entails excising the part of the colon that lacks nerve cells crucial for normal bowel function. Daily enemas (Choice A) can offer temporary relief for constipation but do not address the root cause of the condition, which is the absence of nerve cells. A low-fiber diet (Choice B) is not a primary therapy for Hirschsprung disease and may not effectively manage the disorder. A permanent colostomy (Choice C) is typically considered in severe cases where other interventions have failed and is not the standard management approach for Hirschsprung disease.

5. 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 all right?”
• 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: The most appropriate statement by the nurse in this scenario is to inquire about the family's daily routine. This question allows the nurse to gather information about the family dynamics, the care routine for the infant post-surgery, feeding schedules, and potential stressors. It opens the conversation in a non-intrusive manner and helps the nurse assess the family's situation to provide appropriate support. Choices B, C, and D do not address the situation effectively. Asking about the daily routine is crucial for the nurse to understand the family's needs and offer targeted assistance.

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