Nursing Elites

1. An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 p.m. The fracture was reduced in the emergency department and her arm placed in a cast. At 11 p.m. her mother brings her back to the emergency department due to unrelenting pain that has not been relieved by the prescribed narcotics. Which action would be the priority?

• A. Notifying the doctor immediately
• B. Applying ice
• C. Elevating the arm
• D. Giving additional pain medication as ordered

Correct answer: A

Rationale: The correct action would be to notify the doctor immediately. Unrelenting pain despite medication can indicate compartment syndrome, which is a medical emergency requiring immediate attention. Applying ice, elevating the arm, or giving additional pain medication may not address the underlying cause of the unrelenting pain, which could be a sign of a serious complication like compartment syndrome. Prompt medical evaluation is crucial in this situation to prevent potential complications.

2. During a nap, a 3-year-old hospitalized child wets the bed. How should the nurse respond?

• A. Ask the child to help with remaking the bed.
• B. Put clean sheets on the bed over a rubber sheet.
• C. Change the child’s clothes without discussing the incident.
• D. Explain that children should call the nurse when they need to go to the bathroom.

Correct answer: C

Rationale: When a 3-year-old hospitalized child wets the bed during a nap, the nurse should respond by changing the child’s clothes without discussing the incident. This approach helps to maintain the child's dignity, avoid embarrassment, and reduce anxiety related to bedwetting. Asking the child to help with remaking the bed (Choice A) may not be appropriate as it could cause unnecessary distress. Putting clean sheets on the bed over a rubber sheet (Choice B) addresses the aftermath but does not directly address the child's needs. Explaining that children should call the nurse when they need to go to the bathroom (Choice D) may not be effective in this immediate situation of bedwetting during a nap.

3. A 6-year-old child with a diagnosis of juvenile idiopathic arthritis (JIA) is being discharged. What should the nurse include in the discharge teaching?

• A. Encourage participation in physical activity
• B. Provide a high-calorie diet
• C. Provide a low-sodium diet
• D. Administer intravenous fluids

Correct answer: A

Rationale: Encouraging regular physical activity is crucial in managing symptoms and improving joint function in juvenile idiopathic arthritis. It helps maintain joint mobility, muscle strength, and overall well-being. Providing a high-calorie diet (Choice B) is not typically recommended unless there are specific nutritional concerns or growth issues. A low-sodium diet (Choice C) may be beneficial in conditions like hypertension, but it is not a primary focus for JIA management. Administering intravenous fluids (Choice D) is not a routine part of managing JIA unless specifically indicated for hydration or medication administration.

4. The nurse is assessing a 4-year-old client. Which finding suggests to the nurse this child may have a genetic disorder?

• A. The inquiry determines the child had feeding problems.
• B. The child weighs 40 lb (18.2 kg) and is 40 in (101.6 cm) in height.
• C. The child has low-set ears with lobe creases.
• D. The child can hop on one foot but cannot skip.

Correct answer: C

Rationale: Low-set ears with lobe creases are often associated with genetic disorders, such as Down syndrome, and can indicate underlying chromosomal abnormalities. This physical characteristic is a common feature seen in various genetic syndromes. The other choices, including feeding problems, weight and height measurements, and motor skills, are not typically specific indicators of genetic disorders in the absence of other associated features.

5. What would be important for the nurse to include when teaching an adolescent about tinea pedis?

• A. Keep your feet moist and exposed to the air as much as possible.
• B. Dry the area between your toes thoroughly.
• C. Wear nylon or synthetic socks every day.
• D. Walk barefoot in the school locker room.

Correct answer: B

Rationale: The correct answer is B: 'Dry the area between your toes thoroughly.' When educating an adolescent about tinea pedis, emphasis should be placed on keeping the feet dry, especially between the toes, to minimize the risk of fungal infection. Choice A is incorrect as keeping the feet moist can exacerbate the condition. Choice C is incorrect because nylon or synthetic socks can trap moisture, promoting fungal growth. Choice D is incorrect as walking barefoot in locker rooms increases the risk of contracting tinea pedis from contaminated surfaces.

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