Nursing Elites

1. When providing teaching to the family of a school-age child with juvenile idiopathic arthritis, which instruction should the nurse include?

• A. Limit the child's movement of the large joints.
• B. Encourage the child to perform independent self-care.
• C. Provide the child with a soft mattress for sleeping.
• D. Schedule a 2-hour daily nap for the child in the afternoon.

Correct answer: B

Rationale: Encouraging the child to perform independent self-care is essential when managing juvenile idiopathic arthritis. This instruction helps minimize pain and stiffness in the child's joints while promoting mobility and independence. It is crucial for the child to learn self-management skills early to cope better with the condition in the long term.

2. Which statement best reflects a top-down approach to the evaluation process?

• A. OT focuses on evaluating the child's poor performance in hand skills
• B. OT conducts an assessment to determine a motor age for fine motor and gross motor skills
• C. OT initiates by interviewing the family about routines, interests, and daily habits
• D. OT starts by assessing muscle tone, postural control, and range of motion

Correct answer: C

Rationale: A top-down evaluation approach in occupational therapy begins with understanding the child's daily life, family routines, interests, and habits to ensure that the therapy provided is relevant and meaningful within the child's natural environment. By initiating the evaluation process with family interviews to gather contextual information, the occupational therapist gains a comprehensive view of the child's life, which allows for a more holistic and client-centered approach. Choice A focuses solely on the child's poor performance in hand skills, which is more characteristic of a bottom-up approach. Choice B mentions determining a motor age, which is not necessarily aligned with a top-down assessment. Choice D emphasizes physical assessments like muscle tone and range of motion, which are important but do not capture the essence of a top-down approach that considers the child's environment and routines.

3. Which law provides for infants and toddlers aged 0-2 who are in need of comprehensive early intervention services?

• A. IDEA- Part B
• B. IDEA- Part A
• C. IFSP
• D. IDEA- Part C

Correct answer: D

Rationale: The correct answer is D, IDEA Part C. IDEA Part C specifically focuses on providing early intervention services to infants and toddlers with disabilities. This law ensures that children aged 0-2 receive the necessary support and services to aid in their development and address any disabilities or developmental delays early on. Choices A, B, and C are incorrect. IDEA Part B pertains to services for school-aged children with disabilities, IDEA Part A does not exist in the context of the Individuals with Disabilities Education Act (IDEA), and IFSP stands for Individualized Family Service Plan, which is a document outlining services for children from birth to age 3 who are experiencing developmental delays or disabilities, but it is not a law in itself.

4. A caregiver is providing teaching about car seat use to the mother of a six-month-old infant. Which of the following statements by the mother indicates an understanding of the teaching?

• A. I should secure the car seat using lower anchors and tethers instead of the seat belt
• B. I should position the car seat harness one inch above my baby's shoulders
• C. I will make sure that the car seat is placed at a 90-degree angle
• D. I will pad my baby's car seat with a blanket for traveling long distances

Correct answer: A

Rationale: The correct answer is A. Lower anchors and tethers, known as the LATCH child safety seat system, should be used to secure an infant's car seat in the vehicle. This system provides a safer and more secure way of installing the car seat compared to using the seat belt alone. Using the lower anchors and tethers ensures proper installation and reduces the risk of car seat movement during travel, providing optimal protection for the infant. Choices B, C, and D are incorrect. Choice B is incorrect because the car seat harness should be positioned at or below the baby's shoulders, not above. Choice C is incorrect because the car seat should be positioned at the correct recline angle recommended by the car seat manufacturer, which may not necessarily be 90 degrees. Choice D is incorrect because adding padding like a blanket to the car seat is not recommended as it can interfere with the proper fit and function of the car seat, potentially compromising the safety of the infant.

5. A healthcare professional is preparing to administer a vaccine to a child who has hemophilia. Which of the following actions should the healthcare professional take?

• A. Administer the vaccine subcutaneously
• B. Administer the vaccine intramuscularly
• C. Use a 1-inch needle
• D. Apply pressure to the site for 1 to 2 minutes

Correct answer: B

Rationale: Administering the vaccine intramuscularly to a child with hemophilia is preferred to reduce the risk of bleeding. Hemophiliac individuals have a decreased ability to form blood clots, and administering vaccines intramuscularly reduces the risk of bleeding compared to subcutaneous administration. Using an appropriate needle length and applying pressure to the site post-injection are important steps, but choosing the intramuscular route is crucial in this case to minimize bleeding complications.

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