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. A 3-year-old child has a sudden onset of respiratory distress. The mother denies any recent illnesses or fever. You should suspect:

• A. croup.
• B. foreign body airway obstruction.
• C. lower respiratory infection.
• D. epiglottitis.

Correct answer: B

Rationale: In a 3-year-old child with a sudden onset of respiratory distress and no recent illnesses or fever, the likely cause is a foreign body airway obstruction. Foreign body obstruction can lead to sudden respiratory distress without other preceding symptoms. It is crucial to consider this possibility and act promptly to clear the airway in such cases to prevent serious complications.

3. How should you assist with the delivery of the baby's head?

• A. Grasping each side of the baby's head and gently pulling to facilitate delivery.
• B. Placing your fingers on the bony part of the skull and applying gentle pressure.
• C. Carefully rotating the baby's head to face up during delivery.
• D. Placing the palm of your hand firmly against the back of the baby's skull.

Correct answer: B

Rationale: To assist with the delivery of the baby's head, the correct technique involves placing your fingers on the bony part of the skull and applying gentle pressure. This method helps guide the baby's head through the birth canal safely and effectively. Choices A, C, and D are incorrect. Grasping and pulling the baby's head, rotating the head, or placing the palm of your hand against the back of the baby's skull can potentially cause harm or complications during delivery.

4. When assessing a geriatric patient who has possibly experienced an acute ischemic stroke, which of the following questions would be MOST appropriate to ask?

• A. When did you first notice the symptoms?
• B. Do you have a history of high blood pressure?
• C. What medications do you take and why?
• D. Have you previously had a heart attack?

Correct answer: A

Rationale: The most appropriate question to ask when assessing a geriatric patient who may have experienced an acute ischemic stroke is when the symptoms were first noticed. This information is crucial for determining the time window for potential treatments like thrombolytic therapy, as prompt intervention is necessary for stroke management. Option B is not as relevant in the acute assessment of stroke, though important for overall health history. Option C is important but may not be as time-sensitive as determining symptom onset. Option D focuses on a different cardiac event, not directly related to the current concern of a possible stroke.

5. Before drying off the newborn after birth, which assessment finding should the healthcare professional document to ensure an accurate gestational rating on the Ballard gestational assessment tool?

• A. Amount and area of vernix coverage
• B. Creases on the sole
• C. Size of the areola
• D. Body surface temperature

Correct answer: A

Rationale: To ensure an accurate gestational rating on the Ballard gestational assessment tool, healthcare professionals should document the amount and area of vernix coverage before drying the newborn. Drying the baby after birth could disturb the vernix, potentially affecting the gestational age assessment. Assessing and documenting the vernix coverage beforehand enables a more precise evaluation using the Ballard gestational assessment tool. Choices B, C, and D are incorrect as they are not directly related to gestational rating on the Ballard assessment tool.

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