Nursing Elites

1. During a well-child checkup, the parent of a 5-year-old child reports the child seems much smaller than the 2 older siblings did at this same age. A review of the medical record reveals that the child is 44 inches tall and weighs 42 pounds. What information should be included in the response by the nurse?

• A. The weight of your child at this time is within normal limits for this age but the child is moderately taller than other children this age.
• B. Your child is within the acceptable range for height but the child is significantly smaller in weight for this age.
• C. Your child is within normal limits for weight but the child is slightly shorter in stature than other children this age.
• D. Your child is slightly taller than other children this age but the child’s weight is normal.

Correct answer: D

Rationale: The correct answer is D. The child is slightly taller than average, but the weight is within normal limits. This information should be reassuring to the parent and provides insights into normal growth patterns. Choice A is incorrect as it inaccurately states that the child is taller than other children this age. Choice B is incorrect because the child's weight is actually within normal limits. Choice C is incorrect as it inaccurately states that the child is shorter in stature than other children this age.

2. The mother of a child with cognitive impairment calls the nurse because her son has been gagging and drooling all morning. The nurse suspects foreign body ingestion. What physiologic occurrence is most likely responsible for the presenting signs?

• A. Gastrointestinal perforation may have occurred.
• B. The object may have been aspirated.
• C. The object may be lodged in the esophagus.
• D. The object may be embedded in the stomach wall.

Correct answer: C

Rationale: The symptoms of gagging and drooling suggest that the foreign object is likely lodged in the esophagus. This can cause significant discomfort and potential complications, requiring immediate medical evaluation.

3. What approach is the most appropriate when performing a physical assessment on a toddler?

• A. Demonstrate the use of equipment
• B. Perform traumatic procedures last
• C. Use minimum physical contact initially
• D. Always proceed systematically in a head-to-toe direction

Correct answer: C

Rationale: The most appropriate approach when performing a physical assessment on a toddler is to use minimum physical contact initially. This helps gain the toddler's cooperation and reduces their distress. Performing traumatic procedures last is crucial as they are likely to upset the child and should be handled with care. Demonstrating the use of equipment may be complex for toddlers to understand, so it is not the most appropriate initial approach. Proceeding systematically in a head-to-toe direction is a good practice but using minimum physical contact initially is more important to establish trust and cooperation with the toddler.

4. An eleven-year-old boy is admitted with a history of type 1 diabetes. What information about school age should the nurse use to formulate the teaching plan for daily injections?

• A. The parents do not need to learn the procedure.
• B. The child is old enough to give most of his injections.
• C. Self-injections will be possible when he is closer to adolescence.
• D. The child can learn about self-injections when he is able to reach all injection sites.

Correct answer: B

Rationale: By the age of eleven, many children are capable of administering their own insulin injections with supervision, fostering independence and better management of their diabetes. This age is appropriate for the child to take on more responsibility for their care. While parental involvement is still crucial for supervision and guidance, the child can start to learn and perform the injections themselves. Choice A is incorrect because parental involvement is important for safety and proper technique. Choice C is incorrect as waiting until closer to adolescence may delay the child's ability to manage their diabetes effectively. Choice D is incorrect as reaching injection sites is not the sole criteria; proper technique and supervision are essential.

5. What is the most appropriate action for a healthcare provider if a child presents with suspected meningitis?

• A. Administer antibiotics immediately
• B. Perform a lumbar puncture
• C. Isolate the child
• D. Obtain a complete blood count

Correct answer: C

Rationale: Isolating the child is a priority to prevent the spread of infection until meningitis is confirmed or ruled out. Meningitis, particularly bacterial, is highly contagious and can lead to outbreaks if not properly managed. Isolation and prompt treatment are critical in preventing serious complications. Administering antibiotics immediately without confirmation of the diagnosis can be harmful if the cause is viral or non-infectious. Performing a lumbar puncture is a diagnostic procedure that should be done by a healthcare provider but is not the initial action when suspecting meningitis. Obtaining a complete blood count may be part of the diagnostic workup but is not the most appropriate initial action in suspected meningitis.

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