Nursing Elites

1. A nurse is evaluating a 3-year-old child’s developmental progress. The inability to perform which task indicates to the nurse that there is a developmental delay?

• A. Copying a square
• B. Hopping on one foot
• C. Catching a ball reliably
• D. Using a spoon effectively

Correct answer: A

Rationale: The inability to copy a square at 3 years old indicates a potential developmental delay in fine motor skills. At this age, children should be able to copy basic shapes like circles and crosses. Hopping on one foot is typically expected around the age of 4, catching a ball reliably around 5, and using a spoon effectively by 2-3 years old. Therefore, choices B, C, and D are not as indicative of a developmental delay at 3 years old as the inability to copy a square.

2. A healthcare provider is assessing a child with suspected bacterial meningitis. What is a common clinical manifestation that the provider is likely to observe?

• A. Rash
• B. Photophobia
• C. Jaundice
• D. Kernig sign

Correct answer: D

Rationale: A common clinical manifestation of bacterial meningitis is a positive Kernig sign, which indicates meningeal irritation. Kernig sign is elicited when the leg is bent at the hip and knee at 90-degree angles, and pain and resistance are felt with extension at the knee due to inflamed meninges. Options A, B, and C are not typically associated with bacterial meningitis. A rash is more commonly seen in viral illnesses, photophobia can be present but is not specific to bacterial meningitis, and jaundice is not a typical clinical manifestation of this condition.

3. A parent tearfully tells a nurse, 'They think our child is developmentally delayed. We are thinking about investigating a preschool program for cognitively impaired children.' What is the nurse’s most appropriate response?

• A. Praise the parent for the decision and encourage the plan.
• B. Ask for more specific information related to the developmental delays.
• C. Advise the parent to have the healthcare provider help choose an appropriate program.
• D. Explain that this may be a premature action and the developmental delays could disappear.

Correct answer: B

Rationale: The most appropriate response in this situation is to ask for more specific information related to the developmental delays. By seeking additional details, the nurse can better understand the child's needs and provide tailored guidance and support to the parent. Praising the parent (Choice A) before fully grasping the situation may not be beneficial. Advising the parent to involve the healthcare provider in selecting a program (Choice C) is premature without a comprehensive understanding of the child's developmental delays. Explaining that the delays might resolve on their own (Choice D) is inappropriate as it dismisses the parent's concerns and the necessity for timely and appropriate interventions.

4. Which of the following signs or symptoms is more common in children than adults following head trauma?

• A. nausea and vomiting
• B. altered mental status
• C. tachycardia and diaphoresis
• D. changes in pupillary reaction

Correct answer: A

Rationale: Nausea and vomiting are more common in children following head trauma due to their higher risk of increased intracranial pressure. Children have less space for swelling within the skull compared to adults, making them more prone to experiencing symptoms like nausea and vomiting. Altered mental status and changes in pupillary reaction can also occur in both children and adults following head trauma, but they are not specifically more common in children. Tachycardia and diaphoresis are generally signs of autonomic nervous system activation and may occur in both children and adults, but they are not typically more common in children compared to adults following head trauma.

5. What information should be included in the preoperative plan of care for an infant with myelomeningocele?

• A. Positioning the infant supine with a pillow under the buttocks
• B. Covering the sac with saline-soaked nonadhesive gauze
• C. Wrapping the infant snugly in a blanket
• D. Applying a diaper to prevent fecal soiling of the sac

Correct answer: B

Rationale: Covering the sac with saline-soaked nonadhesive gauze is essential in the preoperative care of an infant with myelomeningocele. This practice helps prevent infection and maintains moisture around the sac before surgery, promoting optimal healing outcomes. Positioning the infant supine with a pillow under the buttocks may be uncomfortable and unnecessary. Wrapping the infant snugly in a blanket does not address the specific care needs of the myelomeningocele. Applying a diaper over the sac can increase the risk of infection and should be avoided in this case.

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