Nursing Elites

1. A major developmental milestone of a toddler is the achievement of autonomy. What should the caregiver instruct the parents to do to enhance their toddler’s need for autonomy?

• A. Teach the child to share with others.
• B. Help the child learn society’s roles.
• C. Teach the child to accept external limits.
• D. Help the child develop internal controls.

Correct answer: D

Rationale: Toddlers are striving for autonomy during this developmental stage. Helping the child to develop internal controls, such as self-regulation and decision-making skills, enhances their sense of autonomy. Choice A, teaching the child to share, focuses more on social skills rather than autonomy. Choice B, helping the child learn society's roles, pertains to socialization rather than autonomy. Choice C, teaching the child to accept external limits, is about compliance with rules rather than fostering autonomy. Therefore, the most appropriate action to enhance a toddler's need for autonomy is to help them develop internal controls.

2. A parent and 4-year-old child who recently emigrated from Colombia arrive at the pediatric clinic. The child has a temperature of 102°F, is irritable, and has a runny nose. Inspection reveals a rash and several small, red, irregularly shaped spots with blue-white centers in the mouth. What illness does the nurse suspect the child has?

• A. Measles
• B. Chickenpox
• C. Fifth disease
• D. Scarlet fever

Correct answer: A

Rationale: The nurse should suspect measles in this child. The presence of a high fever, irritability, runny nose, rash, and Koplik spots (small, red spots with blue-white centers in the mouth) are classic signs of measles. Measles is a highly contagious viral illness that can lead to serious complications if not managed promptly. Chickenpox (choice B) presents with a different rash pattern and does not typically involve Koplik spots. Fifth disease (choice C) and scarlet fever (choice D) also have distinct clinical presentations and are not characterized by the specific symptoms described in this case.

3. A 6-year-old child with a diagnosis of juvenile idiopathic arthritis (JIA) is being discharged. What should the nurse include in the discharge teaching?

• A. Encourage participation in physical activity
• B. Provide a high-calorie diet
• C. Provide a low-sodium diet
• D. Administer intravenous fluids

Correct answer: A

Rationale: Encouraging regular physical activity is essential in managing symptoms and improving joint function in juvenile idiopathic arthritis. Physical activity helps maintain joint mobility, muscle strength, and overall function. Providing a high-calorie diet may not be necessary unless there are specific concerns about the child's nutritional status. A low-sodium diet is not typically a priority in the management of JIA unless the child has comorbid conditions requiring sodium restriction. Administering intravenous fluids is not a standard discharge teaching for JIA unless there are specific medical indications necessitating it.

4. A nurse is assessing a child with suspected pertussis. What clinical manifestation is the nurse likely to observe?

• A. Dry, hacking cough
• B. Inspiratory stridor
• C. Nasal congestion
• D. Severe coughing spells

Correct answer: D

Rationale: The correct answer is D: Severe coughing spells. Pertussis, also known as whooping cough, typically presents with severe coughing spells that can be followed by a characteristic 'whoop' sound. These coughing fits can be intense and prolonged, often causing the child to gasp for air between coughs. Option A, dry hacking cough, is a common symptom of other respiratory conditions like bronchitis. Option B, inspiratory stridor, is more commonly associated with conditions like croup. Option C, nasal congestion, is not a typical symptom of pertussis.

5. A 34-year-old woman, who is 36 weeks pregnant, is having a seizure. After you protect her airway and ensure adequate ventilation, you should transport her

• A. on her left side
• B. in the prone position
• C. in the supine position
• D. in a semi-sitting position

Correct answer: A

Rationale: Transporting a pregnant woman who is having a seizure on her left side is crucial as it helps improve blood flow to the fetus and reduces the risk of further complications. Placing her in the prone position or supine position may compromise blood flow to the fetus and worsen the situation. A semi-sitting position is also not recommended as it may not provide optimal blood flow to the fetus or adequately protect the airway during a seizure.

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