Nursing Elites

1. A nurse working in a pediatric clinic observes the following situations. Which of the following may indicate a delayed child to the nurse?

• A. A 12-month-old that does not 'cruise'.
• B. An 8-month-old that can sit upright unsupported.
• C. A 6-month-old that is rolling prone to supine.
• D. A 3-month-old that does not roll supine to prone.

Correct answer: A

Rationale: The correct answer is 'A 12-month-old that does not 'cruise''. At 12 months, a child should at least be 'cruising' (holding on to objects to walk), which is considered pre-walking. The other choices describe age-appropriate developmental milestones: sitting upright unsupported by 8 months, rolling prone to supine by 6 months, and rolling supine to prone by 3 months. Not 'cruising' at 12 months may indicate a delay in motor skills development.

2. The nurse is checking laboratory values on a patient who has crackling rales in the lower lobes, 2+ pitting edema, and dyspnea with minimal exertion. Which of the following laboratory values does the nurse expect to be abnormal?

• A. Potassium.
• B. B-type natriuretic peptide (BNP).
• C. C-reactive protein (CRP).
• D. Platelets.

Correct answer: B

Rationale: The client's symptoms suggest heart failure. BNP is a neurohormone released from the ventricles due to increased pressure and stretch, as seen in heart failure. A BNP level greater than 51 pg/mL is often associated with mild heart failure, with higher levels indicating more severe heart failure. Potassium levels are not typically affected by heart failure. CRP is an inflammation indicator used to predict coronary artery disease risk, not directly related to heart failure in this case. The client's symptoms do not suggest bleeding or clotting abnormalities associated with platelet count issues, making platelets an unlikely abnormal value.

3. What must the evening nurse do to facilitate the client's ECT treatment the next morning?

• A. Ensure the patient signs an informed consent form
• B. Administer evening medications
• C. Ensure the patient gets a good night's sleep
• D. Provide dietary restrictions as per ECT protocol

Correct answer: A

Rationale: For electroconvulsive therapy (ECT) treatment, obtaining informed consent is crucial before the procedure. This ensures the patient is aware of the risks, benefits, and alternatives to the treatment. Administering medications, ensuring rest, and dietary restrictions are important but not directly related to the specific requirement of obtaining informed consent for ECT. The correct answer, ensuring the patient signs an informed consent form, is essential to uphold the patient's autonomy and ensure they have the necessary information to make an informed decision about their treatment.

4. Which of the following infant behaviors demonstrates the concept of object permanence?

• A. The infant cries when his mother leaves the room.
• B. The infant looks at the floor to find a toy that he was playing with and dropped.
• C. The infant picks up another toy after the one he was playing with rolls under the couch.
• D. The infant participates in a game of patty-cake.

Correct answer: B

Rationale: Object permanence occurs when the infant learns that something or someone still exists even though they might not be able to see it or them. This typically develops between 9 and 10 months of age. The correct answer, 'The infant looks at the floor to find a toy that he was playing with and dropped,' demonstrates object permanence as the infant understands that the toy still exists even though it is temporarily out of sight. Choices A and C do not directly relate to object permanence as the behaviors described do not necessarily indicate an understanding of objects existing when out of sight. Choice D is incorrect as participating in a game of patty-cake does not involve demonstrating object permanence. Peek-a-boo is a more suitable example of a game that demonstrates object permanence, as the infant continues to look for the hidden face, understanding that it still exists even though temporarily unseen.

5. A healthcare professional is screening patients for immunizations. Which of the following is not a contraindication for immunization?

• A. Seizures
• B. Fever lasting more than 3 days
• C. Malignancy within the past 3 months
• D. Illness lasting more than 6 months

Correct answer: D

Rationale: The correct answer is D, 'Illness lasting more than 6 months.' Chronic conditions lasting more than 6 months are not considered a contraindication for immunization. Choice A, 'Seizures,' can be a contraindication in certain situations, especially if linked to a specific vaccine component. Choice B, 'Fever lasting more than 3 days,' can be a temporary precaution but not a general contraindication. Choice C, 'Malignancy within the past 3 months,' is a contraindication due to the compromised immune system in cancer patients.

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