Nursing Elites

1. An infant who has had diarrhea for 3 days is admitted in a lethargic state and is breathing rapidly. The parent states that the baby has been ingesting formula, although not as much as usual, and cannot understand the sudden change. What explanation should the nurse give the parent?

• A. Cellular metabolism is unstable in young children.
• B. The proportion of water in the body is less than in adults.
• C. Renal function is immature in children until they reach school age.
• D. The extracellular fluid requirement per unit of body weight is greater than in adults.

Correct answer: D

Rationale: The correct answer is D. Infants have a higher extracellular fluid requirement per unit of body weight, making them more susceptible to dehydration and electrolyte imbalances during illnesses such as diarrhea. Choice A is incorrect because cellular metabolism being unstable is not the primary explanation for the symptoms described. Choice B is incorrect as the proportion of water in the body alone does not fully explain the increased risk of dehydration in infants. Choice C is incorrect because while renal function is immature in children, it is not the most relevant factor in this scenario compared to the increased fluid requirements.

2. The nurse is teaching the parents of a 1-month-old girl with Down syndrome how to maintain good health for the child. Which instruction would the nurse be least likely to include?

• A. Getting cervical radiographs between 3 and 5 years of age
• B. Adhering to the special dietary needs of the child
• C. Getting an echocardiogram before 3 months of age
• D. Monitoring for symptoms of respiratory infection

Correct answer: B

Rationale: The correct answer is B. While special dietary needs may be important for a child with Down syndrome, they are typically not the primary concern for a 1-month-old. The nurse would be least likely to focus on this aspect as immediate issues such as monitoring for congenital heart defects (echocardiogram), cervical spine abnormalities (radiographs), and respiratory infections are more critical in the early months. Adhering to dietary needs is important, but it is usually addressed as the child grows older and is not the priority during the infant stage.

3. One principle to be followed for children with type 1 diabetes is to provide for the variability of the child’s activity. What should the nurse teach the child about how to compensate for increased physical activity?

• A. Eat more food when planning to exercise more than usual.
• B. Take oral, not injectable insulin, on days of heavy exercise.
• C. Take insulin in the morning when extra exercise is anticipated.
• D. Eat foods that contain sugar to compensate for the extra exercise.

Correct answer: A

Rationale: The correct answer is to eat more food when planning to exercise more than usual. Increased physical activity requires more energy, so additional food intake is necessary to compensate for the increased energy expenditure. This helps maintain blood sugar levels within the target range. Choice B is incorrect because the mode of insulin administration does not change based on physical activity; the type and dose of insulin remain the same unless adjusted by a healthcare provider. Choice C is incorrect because insulin timing should not be adjusted solely based on anticipated exercise; consistent timing of insulin doses is crucial for stable blood sugar control. Choice D is incorrect because consuming foods with sugar may lead to unstable blood sugar levels and is not the recommended way to compensate for extra exercise, as it can result in sudden spikes and drops in blood glucose levels, affecting overall diabetes management.

4. The nurse is assessing a family to determine if they have access to adequate health care. Which statement accurately describes how certain families are affected by common barriers to health care?

• A. After a decade of escalation, the percentage of children living in low-income families has been on the decline since 2000.
• B. White, non-Hispanic children overall are more likely than African American and Hispanic children to be in very good or excellent health.
• C. The proportion of children between the ages of 6 and 18 who are overweight is decreasing, but a large increase is occurring in African American females.
• D. The overall health care plan of working families may improve access to specialty care but limit access to preventive services.

Correct answer: B

Rationale: Choice B is the correct answer because it accurately states that White, non-Hispanic children are more likely to be in very good or excellent health compared to African American and Hispanic children. This reflects a disparity in health outcomes among different racial groups. Choices A, C, and D are incorrect. Choice A is unrelated to the impact of common barriers to health care on families. Choice C talks about overweight children but does not address access to health care. Choice D discusses the impact of the overall health care plan on working families but does not specifically address the disparity in health status among different racial groups.

5. What is the priority intervention for a 10-year-old girl in a foster family?

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

Correct answer: D

Rationale: In a foster family setup, the priority intervention for a 10-year-old girl is to perform a comprehensive health assessment. This is crucial as children in foster care may have moved between different homes, leading to incomplete medical records. A comprehensive health assessment helps identify any health issues, track the child's growth and development, and ensure appropriate medical care. While addressing bullying at school, managing parental expectations, and establishing the primary caretaker are important considerations, the immediate priority for the child's well-being and holistic care is to conduct a thorough health assessment.

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