Nursing Elites

1. A child is being assessed for suspected intussusception. What clinical manifestation is the nurse likely to observe?

• A. Projectile vomiting
• B. Currant jelly stools
• C. Abdominal distension
• D. Constipation

Correct answer: C

Rationale: The correct clinical manifestation that a nurse is likely to observe in a child with suspected intussusception is abdominal distension. Intussusception is a medical emergency where a part of the intestine folds into itself, causing obstruction. Abdominal distension is a common symptom due to the obstruction and the build-up of gases and fluids. While currant jelly stools (Choice B) are a classic sign of intussusception, they are typically seen in later stages of the condition and may not be present during the initial assessment. Projectile vomiting (Choice A) is more commonly associated with conditions like pyloric stenosis. Constipation (Choice D) is not a typical manifestation of intussusception; the condition usually presents with severe colicky abdominal pain and possible passage of blood and mucus in stools.

2. A 2-year-old child is admitted to the hospital with a diagnosis of Kawasaki disease. What is the primary goal of therapy during the acute phase?

• A. Preventing coronary artery aneurysms
• B. Reducing fever
• C. Improving cardiac function
• D. Preventing dehydration

Correct answer: A

Rationale: The primary goal of therapy during the acute phase of Kawasaki disease is to prevent coronary artery aneurysms. Kawasaki disease is characterized by systemic vasculitis and the most serious complication is the development of coronary artery aneurysms. While reducing fever and improving cardiac function are important aspects of managing Kawasaki disease, the primary focus in the acute phase is to prevent the development of coronary artery aneurysms. Preventing dehydration is also essential but not the primary goal in managing Kawasaki disease.

3. An infant is admitted to the neonatal intensive care unit (NICU) with exstrophy of the bladder. What covering should the nurse use to protect the exposed area?

• A. Loose diaper
• B. Dry gauze dressing
• C. Moist sterile dressing
• D. Petroleum jelly gauze pad

Correct answer: C

Rationale: A moist sterile dressing should be used to protect the exposed bladder tissue from infection and injury. Exstrophy of the bladder requires careful management to prevent complications such as infection. A loose diaper (Choice A) may not provide adequate protection or prevent infection. Dry gauze dressing (Choice B) may not be ideal as it could adhere to the exposed area and cause trauma upon removal. Petroleum jelly gauze pad (Choice D) may not be suitable as it can trap moisture and increase the risk of infection.

4. A nurse is assessing a 10-month-old infant. What developmental milestone should the nurse expect to observe?

• A. Crawling
• B. Sitting without support
• C. Standing with assistance
• D. Pulling to a stand

Correct answer: D

Rationale: The correct answer is D: Pulling to a stand. By 10 months of age, most infants should be able to pull themselves up to a standing position while holding onto furniture or other support. This milestone indicates good strength and coordination in the lower body. Choice A, Crawling, is typically achieved around 6-9 months of age. Choice B, Sitting without support, usually occurs around 6-8 months. Choice C, Standing with assistance, can typically be seen around 9-12 months, but pulling to a stand is a more advanced milestone expected by 10 months.

5. The father is being taught by a nurse how to stimulate his 7-year-old son who has a 'slow-to-warm-up' temperament. Which guidance will be most successful?

• A. Telling him to read stories to the child about famous athletes
• B. Suggesting he take the child to watch him play softball
• C. Urging him to sign the child up for little league football
• D. Proposing wrestling with the child and letting him win

Correct answer: A

Rationale: For a child with a 'slow-to-warm-up' temperament, it is important to choose activities that are less intense and allow for gradual engagement. Reading stories to the child about famous athletes would be the most successful approach as it is less active and more likely to be acceptable to the child's temperament. Choice B and C involve more active and potentially overwhelming activities, which may not suit the child's temperament. Choice D, proposing wrestling and letting the child win, might create a competitive environment that could be counterproductive for a 'slow-to-warm-up' child.

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