Nursing Elites

1. Which of the following diseases is caused by the Bordetella pertussis bacterium?

• A. German Measles
• B. RSV
• C. Meningitis
• D. Whooping Cough

Correct answer: D

Rationale: Bordetella pertussis is the bacterium responsible for causing Whooping Cough, also known as pertussis. Meningitis can be caused by various bacteria, but not specifically by Bordetella pertussis. German Measles, also known as Rubella, and RSV (Respiratory Syncytial Virus) are viral infections and are not caused by the Bordetella pertussis bacterium. Therefore, the correct answer is Whooping Cough, caused by Bordetella pertussis.

2. A mother brings her 26-month-old to the well-child clinic. She expresses frustration and anger due to her child's constant saying 'no' and refusal to follow her directions. The nurse explains this is normal for his age, as negativism is attempting to meet which developmental need?

• A. Trust
• B. Initiative
• C. Independence
• D. Self-esteem

Correct answer: C

Rationale: In Erikson's theory of development, toddlers struggle to assert independence. They often use the word 'no' even when they mean yes. This stage is called autonomy versus shame and doubt. The child's behavior of saying 'no' and resisting directions reflects the developmental need for independence, not trust (option A), initiative (option B), or self-esteem (option D). Trust is typically associated with early infancy, initiative with preschool age, and self-esteem with later childhood and adolescence.

3. Your patient has been diagnosed with acute bronchitis. You should expect that all of the following will be ordered EXCEPT:

• A. Increased fluid intake
• B. Cough medications
• C. Antibiotics
• D. Use of a vaporizer

Correct answer: C

Rationale: In the management of acute bronchitis, antibiotics are not typically prescribed unless there is a confirmed bacterial infection. Acute bronchitis is usually caused by a virus, so antibiotics are not effective in treating it. The primary focus is on symptom management and supportive care. Increased fluid intake helps keep the airway moist and liquefy secretions, aiding in their removal. Cough medications can help relieve cough symptoms. The use of a vaporizer can help moisten the air, making breathing more comfortable for the patient. It is crucial to differentiate between viral and bacterial causes of respiratory infections to avoid unnecessary antibiotic use and prevent antibiotic resistance. Therefore, the correct answer is 'Antibiotics.' Increased fluid intake, cough medications, and the use of a vaporizer are commonly recommended for managing symptoms and improving comfort in patients with acute bronchitis.

4. A two-year-old child has sustained an injury to the leg and refuses to walk. The nurse in the emergency department documents swelling of the lower affected leg. Which of the following does the nurse suspect is the cause of the child's symptoms?

• A. Possible fracture of the tibia.
• B. Bruising of the gastrocnemius muscle.
• C. Possible fracture of the radius.
• D. No anatomic injury, the child wants his mother to carry him.

Correct answer: A

Rationale: The child's refusal to walk, along with swelling of the lower leg, indicates a possible fracture, specifically of the tibia. Fractures can cause pain and swelling, leading to difficulty or refusal to bear weight on the affected limb. Choice B, bruising of the gastrocnemius muscle, would not typically result in the child refusing to walk. Choice C, a possible fracture of the radius, is less likely given the location of the swelling and the associated refusal to walk. Choice D, stating no anatomic injury and attributing the child's behavior to wanting to be carried by the mother, is incorrect as the physical findings suggest a potential fracture that needs to be evaluated further.

5. A child is prescribed baclofen (Lioresal) via intrathecal pump to treat severe muscle spasms related to cerebral palsy. What teaching does the nurse provide the child and parents?

• A. Do not let this prescription run out.
• B. The medication may cause gingival hyperplasia.
• C. Periodic serum drug levels are needed.
• D. Watch for excessive facial hair growth.

Correct answer: A

Rationale: The correct teaching for the child and parents when a child is prescribed baclofen via an intrathecal pump is to not let the prescription run out. Abrupt discontinuation of intrathecal baclofen can lead to severe effects like high fever, altered mental status, and rebound spasticity and muscle rigidity. It is crucial for the parents to ensure there is always an adequate supply of this medication to prevent these adverse effects. Choices B and D are incorrect because gingival hyperplasia and hirsutism are side effects associated with phenytoin (Dilantin), not baclofen. Choice C is incorrect as serum drug levels are not typically monitored for intrathecal medications.

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