Nursing Elites

1. After a discussion with the health care provider, the parents of an infant with patent ductus arteriosus (PDA) ask the nurse to explain once again what PDA is. How should the nurse respond?

• A. The diameter of the aorta is enlarged.
• B. The wall between the right and left ventricles is open.
• C. It is a narrowing of the entrance to the pulmonary artery.
• D. It is a connection between the pulmonary artery and the aorta.

Correct answer: D

Rationale: The correct answer is D: 'It is a connection between the pulmonary artery and the aorta.' Patent ductus arteriosus (PDA) is an abnormal connection between the pulmonary artery and the aorta, which normally closes after birth. Choices A, B, and C describe different cardiac conditions and do not accurately define PDA. Choice A is incorrect because PDA does not involve the diameter of the aorta being enlarged. Choice B is incorrect because PDA does not involve the wall between the right and left ventricles being open. Choice C is incorrect because PDA is not a narrowing of the entrance to the pulmonary artery.

2. A 2-year-old child with a diagnosis of hemophilia is admitted to the hospital. What should the nurse include in the care plan?

• A. Encourage participation in contact sports
• B. Use a soft toothbrush for oral care
• C. Administer nonsteroidal anti-inflammatory drugs
• D. Administer aspirin for pain

Correct answer: B

Rationale: The correct answer is to use a soft toothbrush for oral care. Children with hemophilia have a decreased ability to form blood clots, leading to prolonged bleeding. Using a soft toothbrush helps prevent trauma to the gums and oral mucosa, reducing the risk of bleeding. Encouraging participation in contact sports (Choice A) is contraindicated in hemophiliac patients due to the high risk of injury and bleeding. Administering nonsteroidal anti-inflammatory drugs (Choice C) and aspirin (Choice D) should be avoided in hemophilia as they can further increase the risk of bleeding due to their antiplatelet effects.

3. The parents of a 2-year-old child tell the nurse that they are having difficulty disciplining their child. What is the nurse’s most appropriate response?

• A. “This is a challenging age for your child right now.”
• B. “Could you elaborate on your challenges? I’m not clear on what you mean.”
• C. “It’s important to be consistent with toddlers when they need discipline.”
• D. “I understand your concern. This phase is often referred to as the 'terrible twos'.”

Correct answer: C

Rationale: The most appropriate response for the nurse is to emphasize the importance of consistency in discipline when dealing with toddlers. Toddlers are at a stage where they are exploring boundaries and learning what behaviors are acceptable. By being consistent, parents can help reinforce these boundaries and teach appropriate behaviors effectively. Choices A, B, and D do not provide specific guidance on how to address the discipline issue effectively. While acknowledging the challenges of this age (Choice A) and empathizing with the parents (Choice D) are important, the key point in this scenario is to highlight the significance of consistency in discipline (Choice C).

4. The father is being taught by a nurse how to stimulate his 7-year-old son who has a 'slow-to-warm-up' temperament. Which guidance will be most successful?

• A. Telling him to read stories to the child about famous athletes
• B. Suggesting he take the child to watch him play softball
• C. Urging him to sign the child up for little league football
• D. Proposing wrestling with the child and letting him win

Correct answer: A

Rationale: For a child with a 'slow-to-warm-up' temperament, it is important to choose activities that are less intense and allow for gradual engagement. Reading stories to the child about famous athletes would be the most successful approach as it is less active and more likely to be acceptable to the child's temperament. Choice B and C involve more active and potentially overwhelming activities, which may not suit the child's temperament. Choice D, proposing wrestling and letting the child win, might create a competitive environment that could be counterproductive for a 'slow-to-warm-up' child.

5. When you attempt to assess a 22-year-old woman who has been sexually assaulted, and she orders you not to touch her, your most appropriate initial action should be to

• A. ask the patient to sign a release form
• B. ask a female EMT-B to attempt to assess the patient
• C. explain to the patient that she must be examined
• D. transport the patient without performing an assessment

Correct answer: B

Rationale: In this scenario, the patient has requested not to be touched, indicating a need for sensitivity and understanding. Asking a female EMT-B to attempt to assess the patient is the most appropriate initial action as it respects the patient's need for privacy, comfort, and potentially reduces re-traumatization. Asking the patient to sign a release form (Choice A) is not suitable as it disregards the patient's immediate concerns. Explaining to the patient that she must be examined (Choice C) may further distress her and violate her autonomy. Transporting the patient without performing an assessment (Choice D) ignores the patient's expressed wishes and may lead to inadequate care.

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