Nursing Elites

1. A toddler has recently been diagnosed with cerebral palsy. Which of the following information should the nurse provide to the parents? Select one that doesn't apply.

• A. Regular developmental screening is important to avoid secondary developmental delays.
• B. Cerebral palsy is caused by injury to the upper motor neurons and results in motor dysfunction, as well as possible ocular and speech difficulties.
• C. Developmental milestones may be slightly delayed but usually will require no additional intervention.
• D. Parent support groups are helpful for sharing strategies and managing health care issues.

Correct answer: C

Rationale: The correct answer is 'Developmental milestones may be slightly delayed but usually will require no additional intervention.' This statement is incorrect as delayed developmental milestones in a child with cerebral palsy require interventions and constant follow-ups. Developmental monitoring is essential to track a child's growth and development over time. If any concerns are raised during monitoring, a developmental screening test should be conducted promptly to address any developmental delays or issues. Regular interventions, therapies, and support are crucial to optimize the child's development and well-being. Therefore, it is important for parents to be aware that additional interventions may be necessary to support their child's development.

2. What is a key principle of patient teaching that must take place to ensure patient safety?

• A. Family members should be present
• B. Teaching must be documented
• C. Understanding must be confirmed
• D. Teaching should be provided by multiple staff members

Correct answer: C

Rationale: A key principle of patient teaching that ensures patient safety is the confirmation of understanding. To ensure patient safety, it is crucial to confirm that the patient comprehends the information provided. This confirmation can be achieved by having the patient repeat back the information or demonstrate understanding through return demonstration. Documenting the patient's understanding is essential to track the effectiveness of the teaching session and ensure that the patient is equipped with the necessary knowledge for their safety. Family members being present or having multiple staff members provide teaching may be beneficial in certain situations, but the primary focus should be on confirming the patient's understanding to enhance safety and promote effective learning.

3. Which of the following conditions may cause an increased respiratory rate?

• A. Stooped posture
• B. Narcotic analgesics
• C. Injury to the brain stem
• D. Anemia

Correct answer: D

Rationale: Anemia can lead to an increased respiratory rate. In anemia, there are decreased levels of hemoglobin in red blood cells, which are responsible for carrying oxygen to the body's tissues. To compensate for the reduced oxygen-carrying capacity, the body increases the respiratory rate to bring in more oxygen. Stooped posture (Choice A) is not directly related to an increased respiratory rate. Narcotic analgesics (Choice B) are more likely to cause a decreased respiratory rate due to their central nervous system depressant effects. Injury to the brain stem (Choice C) can affect respiratory function but may not necessarily lead to an increased respiratory rate.

4. A client is admitted to a nursing unit with a remittent fever. Which statement best describes this pattern of fever?

• A. A fever that spikes and then lowers without returning to normal
• B. A fever that lasts 2 days followed by normal temperature for 2 days, followed by fever again
• C. A fever that lasts 2 days followed by normal temperature for 12 hours, followed by fever again
• D. A persistent fever that has lasted over 24 hours

Correct answer: A

Rationale: A remittent fever is characterized by temperature fluctuations where the fever spikes and then lowers but does not return to normal temperature. Option A best describes this pattern of fever. Option B describes a pattern of fever known as a biphasic fever, where the fever alternates between days of fever and normal temperature. Option C describes a pattern of fever that is more indicative of an intermittent fever, where the fever lasts for a specific duration followed by an interval of normal temperature. Option D does not accurately describe a remittent fever, as it suggests a persistent fever that has lasted over 24 hours, which is not specific to the remittent pattern.

5. The client with multiple sclerosis is being educated by the nurse on exercises and physical activities. Which statement by the client indicates a need for further teaching?

• A. "I can lift weights and engage in resistance training."?
• B. "I should exercise until I am exhausted."?
• C. "I can incorporate aerobic exercises into my routine."?
• D. "I should perform proper stretching before starting my routine."?

Correct answer: B

Rationale: The correct answer is, "I should exercise until I am exhausted."? This statement indicates a need for further teaching because patients with multiple sclerosis should avoid exercising to the point of exhaustion or fatigue. Strenuous physical activity can increase body temperature and potentially worsen symptoms in individuals with multiple sclerosis. Choice A is correct because lifting weights and resistance training can be appropriate exercises for patients with multiple sclerosis. Choice C is valid because aerobic exercises can also be beneficial. Choice D is accurate as proper stretching before starting an exercise routine is essential for preventing injuries.

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