Nursing Elites

1. In conducting a health screening for 12-month-old children, the nurse expects them to have been immunized against which of the following diseases?

• A. measles, polio, pertussis, hepatitis B
• B. diphtheria, pertussis, polio, tetanus
• C. rubella, polio, pertussis, hepatitis A
• D. measles, mumps, rubella, polio

Correct answer: B

Rationale: By 12 months of age, children should have received vaccines for diphtheria, pertussis, polio, and tetanus (DTaP and IPV). The correct answer is B as it includes these vaccines that are typically administered in the first year of life. Measles, mumps, and rubella (MMR) vaccination usually begins at 12 months of age but is not expected to be completed by this time. Choices A and C are incorrect as they include diseases that are not part of the routine immunization schedule for a 12-month-old child.

2. When testing the function of the oculomotor, trochlear, and abducens nerves, which parameter does a nurse check to determine their function?

• A. Tongue symmetry
• B. Eye movements
• C. Facial symmetry
• D. Corneal reflex

Correct answer: B

Rationale: The correct answer is B: Eye movements. When assessing the oculomotor, trochlear, and abducens nerves, evaluating eye movements is crucial. This assessment includes checking the pupils for size, regularity, equality, light reactions, accommodation, and extraocular movements in various gaze positions. Tongue symmetry is primarily used to evaluate cranial nerve XII (hypoglossal nerve) function. Facial symmetry is a key indicator of cranial nerve VII (facial nerve) function. The corneal reflex assesses sensory afferents in cranial nerve V (trigeminal nerve) and motor efferents in cranial nerve VII (facial nerve).

3. The nurse is assessing an 18-month-old. Which of these statements made by the parent or caregiver would require follow-up?

• A. I'm worried that my child is not using two-word phrases yet.
• B. My child has recently taken a few steps but does not seem stable when standing.
• C. My child seems to have developed separation anxiety when I leave.
• D. I'm letting my child use a spoon to eat.

Correct answer: B

Rationale: The correct answer is 'My child has recently taken a few steps but does not seem stable when standing.' By 18 months of age, children should have taken their first steps and stand well. If a child hasn't made progress by this age, a physical therapy evaluation may be necessary. It is normal for an 18-month-old to start using a spoon to eat. However, the use of two-word phrases is not typically expected until 2 years of age. Separation anxiety is a common developmental phase that typically occurs between 6 and 18 months, so it does not require immediate follow-up. Therefore, the statement about the child not being stable when standing raises a red flag and necessitates further evaluation.

4. How should a client's neck be positioned for palpation of the thyroid?

• A. flexed toward the side being examined
• B. hyperextended directly backward
• C. flexed away from the side being examined
• D. flexed directly forward

Correct answer: A

Rationale: The correct way to position a client's neck for palpation of the thyroid is to have it flexed toward the side being examined. This positioning helps to better access and palpate the thyroid gland. Option B, hyperextending the neck directly backward, is incorrect as it can make palpation more difficult and uncomfortable for the client. Option C, flexing the neck away from the side being examined, is also incorrect as it may obscure the thyroid gland, making it harder to palpate. Option D, flexing the neck directly forward, is not ideal for thyroid palpation as it does not provide the best access to the gland.

5. What is one of the main goals of Healthy People 2010?

• A. reduction of health care costs
• B. elimination of health disparities
• C. investigation of substance abuse
• D. determination of an acceptable morbidity rate

Correct answer: C

Rationale: The main goal of Healthy People 2010 is the elimination of health disparities among the U.S. population. This initiative outlines specific objectives to improve the overall health of Americans by addressing disparities in health outcomes. Choice A, reduction of health care costs, is not the primary goal of Healthy People 2010, although it may be a beneficial outcome. Choice C, investigation of substance abuse, is not a main goal of Healthy People 2010; while substance abuse may be a factor in health disparities, the primary focus is on broader disparities. Choice D, determination of an acceptable morbidity rate, is not the main focus of Healthy People 2010; instead, it aims to address health disparities in different population groups.

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