Nursing Elites

1. A parent brings an 18-month-old toddler to the clinic. The parent states, 'My child is so difficult to please, has temper tantrums, and annoys me by throwing food from the table.' What is the nurse’s best response?

• A. “Toddlers need discipline to prevent the development of antisocial behaviors.”
• B. “Toddlers are learning to assert independence, and this behavior is expected at this age.”
• C. “It is best to leave the toddler alone in the crib after calmly explaining why the behavior is unacceptable.”
• D. “This is the way a toddler expresses needs, and this behavior is acceptable during the initiative stage of development.”

Correct answer: B

Rationale: The correct answer is B: “Toddlers are learning to assert independence, and this behavior is expected at this age.” At 18 months, toddlers are in the stage of developing autonomy and independence. They may exhibit behaviors like temper tantrums and defiance as they assert their independence and test limits. It is crucial for parents and caregivers to understand that these behaviors are typical for toddlers at this age. Choice A is incorrect because discipline should be age-appropriate and focus on positive reinforcement rather than preventing antisocial behaviors. Choice C is inappropriate as leaving a toddler alone in a crib after explaining unacceptable behavior is not a recommended approach and can lead to feelings of abandonment. Choice D is inaccurate as the described behavior is more related to asserting independence rather than the initiative stage of development.

2. What should be the priority action when caring for a child with acute laryngotracheobronchitis?

• A. Initiate measures to reduce fever.
• B. Ensure delivery of humidified oxygen.
• C. Provide support to reduce apprehension.
• D. Continually assess the respiratory status.

Correct answer: D

Rationale: When caring for a child with acute laryngotracheobronchitis, the priority action should be to continually assess the respiratory status. This is crucial to detect early signs of respiratory distress, such as worsening stridor or increased work of breathing. Prompt intervention can prevent further deterioration of the child's condition. Initiating measures to reduce fever (Choice A) may be necessary but is not the priority in this situation. Ensuring delivery of humidified oxygen (Choice B) is important for maintaining oxygenation but should follow the assessment of respiratory status. Providing support to reduce apprehension (Choice C) is also important for the child's comfort but is not the priority over assessing and managing respiratory distress.

3. A child with a diagnosis of celiac disease is admitted to the hospital. What dietary restriction should the nurse teach the parents?

• A. Avoid dairy products
• B. Avoid gluten
• C. Avoid high-fat foods
• D. Avoid foods high in sugar

Correct answer: B

Rationale: The correct answer is B: 'Avoid gluten.' Children with celiac disease must follow a gluten-free diet to prevent symptoms and intestinal damage. Gluten is a protein found in wheat, barley, and rye, which triggers an immune response in individuals with celiac disease. Choices A, C, and D are incorrect because while some individuals with celiac disease may also have lactose intolerance or may need to manage fat or sugar intake for overall health, the primary dietary restriction for celiac disease is avoiding gluten to maintain gastrointestinal health.

4. A 10-year-old girl is living with a foster family. Which intervention is the priority for the child in this family structure?

• A. Determining if the child is being bullied at school
• B. Dealing with mixed expectations of parents
• C. Establishing who is the child's actual caretaker
• D. Performing a comprehensive health assessment

Correct answer: D

Rationale: Performing a comprehensive health assessment is crucial for a child living with a foster family as they may have moved between different homes, leading to incomplete medical records. This assessment helps identify any existing health issues, ensure appropriate care, and address any unmet health needs. While addressing issues like bullying or parental expectations is important, the immediate priority should be ensuring the child's overall health and well-being. Establishing the actual caretaker is also important but may not be as urgent as addressing potential health concerns.

5. A parent calls the outpatient clinic requesting information about the appropriate dose of acetaminophen for a 16-month-old child who has signs of an upper respiratory tract infection and fever. The directions on the bottle of acetaminophen elixir are 120 mg every 4 hours when needed. At the toddler’s 15-month visit, the health care provider prescribed 150 mg. What is the nurse’s best response to the parent?

• A. “The dose is close enough, and it doesn’t really matter which one is given.”
• B. “From your description, the medications are not necessary. They should be avoided at this age.”
• C. “It is appropriate to use dosages based on age. Children typically have weights consistent for their age groups.”
• D. “The prescribed dose of the drug was based on weight, and this is a more accurate way of determining a therapeutic dose.”

Correct answer: D

Rationale: The most accurate way to determine a therapeutic dose for children is based on their weight rather than age. Weight-based dosing helps ensure that the child receives the appropriate amount of medication for their body size, which is crucial for safety and effectiveness. Age-based dosing can lead to underdosing or overdosing, as children of the same age can have significantly different weights. Choice A is incorrect because even small variations in dosages can have significant effects on a child's health. Choice B is incorrect as acetaminophen can be appropriate when used correctly for fever management in children. Choice C is incorrect as children's weights can vary greatly within the same age group, making weight-based dosing more precise and individualized.

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