Nursing Elites

1. Mr. Lopez has a 7-year-old son with growth hormone (GH) deficiency. He shares with the nurse the desire of his son to play ball games. However, his wife feels the child will be in danger since he is smaller than the other children. In planning anticipatory guidance for these parents, the nurse should keep in mind which of the following?

• A. The child should be allowed to play because doing so can foster healthy self-esteem
• B. The risk for fractures is increased because GH deficiency results in fragile bones
• C. Activity could aggravate insulin sensitivity, causing hyperglycemia
• D. Activity would aggravate the child's joints, already overtasked by obesity

Correct answer: A

Rationale: Children with GH deficiency may face challenges due to their size, but it is important to encourage their participation in activities like playing ball games to promote healthy self-esteem. Allowing the child to play can help in building confidence and a sense of accomplishment, which are essential for their overall well-being.

2. The caregiver is teaching a new mother about infant safety. Which statement indicates that further teaching is needed?

• A. I will place my baby on their back to sleep.
• B. I will keep soft toys and pillows out of the crib.
• C. I will use a car seat for every car ride.
• D. I will allow my baby to sleep in my bed.

Correct answer: D

Rationale: Allowing a baby to sleep in an adult bed increases the risk of suffocation and Sudden Infant Death Syndrome (SIDS). It is safer for infants to sleep on a firm, flat surface in their own crib or bassinet to reduce the risk of accidental suffocation or strangulation. Therefore, the caregiver should be advised against co-sleeping with the infant to ensure the baby's safety.

3. Which of the following statements regarding two-rescuer child CPR is correct?

• A. The chest should be compressed with one hand, and a compression-to-ventilation ratio of 30:2 should be delivered.
• B. A compression-to-ventilation ratio of 15:2 should be delivered with pauses in compressions to give ventilations.
• C. The chest should be allowed to fully recoil between compressions to optimize venous return.
• D. Compress the chest with one or two hands to a depth equal to one third the diameter of the chest.

Correct answer: D

Rationale: In two-rescuer child CPR, the correct compression depth is one third the diameter of the chest. This depth can be achieved by compressing the chest with one or two hands. It is crucial to follow the correct compression depth guideline to ensure effective chest compressions and circulation during CPR for a child.

4. Which of the following is a more reliable indicator of perfusion in children than in adults?

• A. Blood pressure
• B. Heart rate
• C. Respiratory rate
• D. Capillary refill

Correct answer: D

Rationale: Capillary refill is a more reliable indicator of perfusion in children than in adults. This is because children have more compliant vessels, making capillary refill a more sensitive indicator of perfusion status in this population. In contrast, while blood pressure, heart rate, and respiratory rate are important indicators, they may not be as reliable in children as capillary refill. Blood pressure can be affected by various factors such as anxiety or pain, heart rate can be influenced by emotions or temperature, and respiratory rate may vary with activity levels. Therefore, capillary refill is preferred in children for a more accurate assessment of perfusion.

5. Physical abuse of a 4-year-old child should be suspected if you observe:

• A. purple and yellow bruises on the thighs.
• B. bruises on the anterior tibial area.
• C. the child clinging to his or her parent.
• D. curious siblings watching you.

Correct answer: A

Rationale: Purple and yellow bruises on protected areas like the thighs are concerning as they indicate bruises in various stages of healing, which is a red flag for physical abuse. Bruises on the anterior tibial area or a child clinging to a parent are not specific signs of physical abuse. Siblings watching you is unrelated to the suspicion of physical abuse in this scenario.

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