Nursing Elites

1. A nurse is planning care for a school-age child who has thrombocytopenia. Which of the following interventions should the nurse include in the plan?

• A. Administer aspirin as needed for fever.
• B. Avoid venipunctures whenever possible.
• C. Encourage the child to participate in contact sports.
• D. Administer ibuprofen for pain.

Correct answer: B

Rationale: The correct answer is B: 'Avoid venipunctures whenever possible.' Thrombocytopenia is a condition characterized by a low platelet count, which can lead to an increased risk of bleeding. Venipunctures can cause bleeding in these patients; therefore, they should be avoided whenever possible. Choice A is incorrect because aspirin should be avoided in patients with thrombocytopenia as it can further increase the risk of bleeding due to its antiplatelet effects. Choice C is incorrect because participating in contact sports can also increase the risk of injury and bleeding in a child with thrombocytopenia. Choice D is incorrect as ibuprofen, like aspirin, can also increase the risk of bleeding and should be avoided in these patients.

2. Why is the specific gravity for infants lower than for older children?

• A. Infants have a greater body surface area.
• B. Infants have a higher basal metabolic rate.
• C. Infants have a greater percentage of body weight that is water.
• D. Infants' kidneys are less able to concentrate urine.

Correct answer: D

Rationale: The correct answer is D because infants' kidneys are less developed compared to older children, making them less efficient at concentrating urine. This results in a lower specific gravity in infants. The other choices do not directly explain why the specific gravity is lower in infants.

3. A client has a new diagnosis of celiac disease. Which of the following clinical manifestations should the nurse expect?

• A. Steatorrhea
• B. Projectile vomiting
• C. Sunken abdomen
• D. Weight gain

Correct answer: A

Rationale: Celiac disease is a condition where individuals are unable to digest gluten, leading to damage in the bowel cells and subsequent malabsorption. This malabsorption commonly presents with symptoms such as steatorrhea, which is characterized by foul-smelling, greasy, and bulky stools due to high fat content. Projectile vomiting and sunken abdomen are not typical manifestations of celiac disease. Weight gain is unlikely in individuals with celiac disease due to malabsorption and nutrient deficiencies. Therefore, the nurse should expect steatorrhea as a clinical manifestation in clients with celiac disease.

4. Which statement most reflects the observation that the infant sleeps soundly, awakens on his own, and maintains a quiet alert state?

• A. This is atypical behavior and should be addressed
• B. The infant should remain on high alert when awake
• C. This shows the infant is making neurological gains
• D. The family is disrupting the child's sleep patterns

Correct answer: C

Rationale: A quiet alert state in infants indicates positive neurological development. It showcases the infant's ability to regulate sleep-wake cycles and maintain an optimal state for learning and interaction. Therefore, observing an infant who sleeps soundly, awakens on his own, and stays in a quiet alert state is a reassuring sign of neurological gains and healthy development. Choice A is incorrect as it misinterprets normal behavior as atypical. Choice B is incorrect as it suggests the infant should be on high alert, which is not developmentally appropriate. Choice D is incorrect as it falsely blames the family for disrupting the child's sleep patterns, whereas the scenario described indicates positive neurological growth.

5. A 9-month-old infant who is not sitting independently has been diagnosed with ataxic cerebral palsy (CP). Which clinical manifestations would the nurse expect to see in the baby?

• A. Hypotonia and muscle instability
• B. Hypertonia and persistence of primitive reflexes
• C. Tremors and exaggerated posturing
• D. Hemiplegia and hypertonia

Correct answer: A

Rationale: In ataxic cerebral palsy, the characteristic features include hypotonia (low muscle tone) and muscle instability. These manifestations contribute to the infant's difficulty in achieving independent sitting. Hypertonia (increased muscle tone) and persistence of primitive reflexes, as mentioned in option B, are more commonly associated with other types of cerebral palsy like spastic CP. Tremors and exaggerated posturing (option C) are not typical features of ataxic CP. Hemiplegia (paralysis of one side of the body) and hypertonia (increased muscle tone) mentioned in option D are more commonly seen in other types of cerebral palsy, such as spastic CP.

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