Nursing Elites

1. When describing urticaria, what would an instructor include?

• A. It is a type IV hypersensitivity reaction.
• B. Histamine release leads to vasodilation.
• C. Wheals appear first followed by erythema.
• D. The nonpruritic rash blanches with pressure.

Correct answer: B

Rationale: The correct answer is B. Urticaria is a type I hypersensitivity reaction where histamine release leads to vasodilation and the formation of characteristic wheals. Choice A is incorrect as urticaria is associated with type I hypersensitivity, not type IV. Choice C is incorrect because in urticaria, erythema typically appears before the development of wheals. Choice D is incorrect as urticaria is typically pruritic and does not blanch with pressure.

2. The parents of a 1-month-old girl with Down syndrome are being taught by the nurse on how to maintain the child's good health. 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, they are not typically a primary concern for a 1-month-old with Down syndrome compared to monitoring for congenital issues. Getting cervical radiographs, an echocardiogram, and monitoring for respiratory infections are more crucial in the early care of a child with Down syndrome. Cervical radiographs help in assessing for atlantoaxial instability, an echocardiogram is important for detecting congenital heart defects common in Down syndrome, and monitoring for respiratory infections is vital due to the increased risk in these children.

3. A 34-year-old woman, who is 36 weeks pregnant, is having a seizure. After you protect her airway and ensure adequate ventilation, you should transport her

• A. on her left side
• B. in the prone position
• C. in the supine position
• D. in a semi-sitting position

Correct answer: A

Rationale: Transporting a pregnant woman who is having a seizure on her left side is crucial as it helps improve blood flow to the fetus and reduces the risk of further complications. Placing her in the prone position or supine position may compromise blood flow to the fetus and worsen the situation. A semi-sitting position is also not recommended as it may not provide optimal blood flow to the fetus or adequately protect the airway during a seizure.

4. The nurse is assessing a 3-year-old boy whose parents brought him to the clinic when they noticed that the right side of his abdomen was swollen. What finding would suggest this child has a neuroblastoma?

• A. The child has a maculopapular rash on his palms.
• B. The parents report that their son is vomiting and not eating well.
• C. The parents report that their son is irritable and not gaining weight.
• D. Auscultation reveals wheezing with diminished lung sounds.

Correct answer: B

Rationale: Vomiting and poor appetite are common symptoms of neuroblastoma, a malignancy that arises from neural crest cells in the adrenal glands or sympathetic nervous system. This tumor can cause abdominal swelling due to its location and size, leading to symptoms like vomiting and decreased appetite. The presence of a maculopapular rash on the palms (Choice A) is not a typical finding associated with neuroblastoma. Irritability and failure to thrive (Choice C) are nonspecific symptoms that can be seen in various conditions but are not specifically indicative of neuroblastoma. Auscultation revealing wheezing with diminished lung sounds (Choice D) may suggest respiratory conditions rather than neuroblastoma.

5. Which of the following parameters would be LEAST reliable when assessing the perfusion status of a 2-year-old child with possible shock?

• A. distal capillary refill
• B. systolic blood pressure
• C. skin color and temperature
• D. presence of peripheral pulses

Correct answer: B

Rationale: Systolic blood pressure is the least reliable parameter when assessing the perfusion status of a 2-year-old child with possible shock. In pediatric patients, especially young children, blood pressure may not decrease until significant shock has already occurred, making it a late indicator of inadequate perfusion. Depending solely on systolic blood pressure to evaluate perfusion status in this age group can lead to a delay in appropriate interventions. Distal capillary refill time, skin color, and temperature changes, and the presence of peripheral pulses are more sensitive and early indicators of perfusion status in pediatric patients. Monitoring distal capillary refill provides information on peripheral perfusion, while changes in skin color and temperature can signal circulatory compromise. Evaluating the presence or absence of peripheral pulses offers insights into vascular perfusion. These parameters offer more reliable and prompt feedback on a child's perfusion status compared to systolic blood pressure.

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