Nursing Elites

1. During a well-baby check of a 6-month-old infant, the nurse notes abrasions and petechiae of the palate. The nurse should:

• A. inquire about the possibility of sexual abuse.
• B. ask about the types of foods the child is eating.
• C. request to see the type of bottle used for feedings.
• D. question the parent about objects the child plays with.

Correct answer: A

Rationale: The correct answer is to inquire about the possibility of sexual abuse. Injuries to the soft palate such as bruising, abrasions, and petechiae can be signs of sexual abuse in infants. While oral sex may not leave significant physical evidence, these findings should raise suspicion. Option A is correct as it focuses on addressing potential abuse. Options B, C, and D are incorrect because the child's diet, the type of bottle used for feedings, and play objects are not likely related to the observed injuries. The presence of oral injuries suggests considering sexual abuse rather than other factors.

2. A 26-year-old single woman is knocked down and robbed while walking her dog one evening. Three months later, she presents at the crisis clinic, stating that she cannot put this experience out of her mind. She complains of nightmares, extreme fear of being outside or alone, and difficulty eating and sleeping. What is the best response by the nurse?

• A. "I will ask the physician to prescribe medication for you."?
• B. "That must have been a very difficult and frightening experience. It might be helpful to talk about it."?
• C. "In the future, you might walk your dog in a more populated area or hire someone else to take over this task."?
• D. "Have you thought of moving to a safer neighborhood?"?

Correct answer: B

Rationale: Choice B is the best response as it provides empathy and encourages the client to talk about her experience, which can be therapeutic. This approach validates the client's feelings and offers support. By acknowledging the difficulty and fear experienced by the client, the nurse opens the door for the client to express her emotions and begin the process of coping with the trauma. Choices A, C, and D do not address the emotional impact of the traumatic event or provide an opportunity for the client to express her feelings and concerns. Choice A immediately jumps to medication without exploring other supportive interventions. Choice C focuses on practical solutions without addressing the client's emotional needs. Choice D suggests a drastic solution without considering the client's emotional state or preferences.

3. The client is taking prednisone 7.5mg po each morning to treat his systemic lupus erythematosus. Which statement best explains the reason for taking the prednisone in the morning?

• A. There is less chance of forgetting the medication if taken in the morning.
• B. There will be less fluid retention if taken in the morning.
• C. Prednisone is absorbed best with the breakfast meal.
• D. Morning administration mimics the body's natural secretion of corticosteroid.

Correct answer: D

Rationale: Taking corticosteroids in the morning mimics the body's natural release of cortisol, which follows a diurnal pattern with higher levels in the morning. This timing helps regulate the body's inflammatory response and minimizes potential side effects. Answer A is not the primary reason for morning dosing, as adherence concerns can be addressed through other means. Answer B is incorrect since fluid retention is not influenced by the timing of prednisone administration. Answer C is also incorrect as prednisone absorption is not significantly affected by whether it is taken with breakfast or not.

4. A two-year-old has been in the hospital for 3 weeks and has seldom seen family members due to isolation precautions. Which of the following hospitalization changes is most likely to be occurring?

• A. Guilt
• B. Trust
• C. Separation anxiety
• D. Shame

Correct answer: C

Rationale: The correct answer is 'Separation anxiety.' Separation anxiety is a common response in young children when they are separated from their primary caregivers for extended periods. In this case, the two-year-old being in the hospital for three weeks and not being able to see family members due to isolation precautions can trigger separation anxiety. 'Guilt' is a feeling of responsibility for wrongdoing, which is not the most likely change occurring in this scenario. 'Trust' involves reliance and confidence in others, not typically associated with prolonged separation from family. 'Shame' is a negative emotion related to feeling disgrace, which is not the most appropriate response in this hospitalization situation.

5. During discharge teaching for a client with diverticulitis on a low-roughage diet, which food should be eliminated from the diet?

• A. Roasted chicken
• B. Noodles
• C. Cooked broccoli
• D. Custard

Correct answer: C

Rationale: The client with diverticulitis needs to avoid gas-forming foods that can increase abdominal discomfort. Cooked broccoli is a high-fiber food that can worsen symptoms. Roasted chicken, noodles, and custard are suitable choices for a low-roughage diet as they are less likely to cause gas formation or abdominal discomfort.

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