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. You are dispatched to a residence for a 4-year-old female who is sick. Your assessment reveals that she has increased work of breathing and is making a high-pitched sound during inhalation. Her mother tells you that she has been running a high fever for the past 24 hours. Your MOST immediate concern should be:

• A. determining if the child has a history of croup.
• B. preparing to treat her for a febrile seizure.
• C. assessing the need for ventilation assistance.
• D. taking her temperature to see how high it is.

Correct answer: C

Rationale: In a child with increased work of breathing, a high-pitched sound during inhalation, and a high fever, upper airway obstruction should be suspected. The child's condition may require immediate ventilation assistance to ensure adequate oxygenation and ventilation. Therefore, the most immediate concern in this scenario is to assess the need for ventilation assistance.

3. Which of the following is an abnormal finding when assessing the abdomen of a newborn?

• A. The umbilical cord has two arteries and one vein.
• B. The presence of green vomit.
• C. The liver is palpable 1 to 2 cm below the costal margin.
• D. The abdomen is soft and nondistended.

Correct answer: B

Rationale: The correct answer is B. The presence of green vomit in a newborn is an abnormal finding and indicates a possible intestinal obstruction. This finding requires immediate attention and further investigation. Choices A, C, and D are normal findings in a newborn's abdomen assessment. A newborn typically has an umbilical cord with two arteries and one vein, a liver that may be palpable 1 to 2 cm below the costal margin due to its normal size in a neonate, and a soft, nondistended abdomen as expected in healthy newborns.

4. A 3-month-old is hospitalized with a fractured femur. The pain assessment tool most appropriate for this child is the:

• A. FLACC scale.
• B. Poker chip tool.
• C. Number scale.
• D. Visual analog scale.

Correct answer: A

Rationale: The FLACC scale is a validated pain assessment tool suitable for infants and young children, including 3-month-olds. It assesses pain based on five categories: Face, Legs, Activity, Cry, and Consolability. Since infants cannot communicate their pain verbally, the FLACC scale is effective in evaluating pain by observing these behavioral indicators. The other options, such as the Poker chip tool, Number scale, and Visual analog scale, are not specifically designed for infants and may not provide accurate pain assessment in this age group.

5. Use the scenario to answer questions 13-18. A patient has come to the OPD with complaints of anaesthesia and paresthesia of the lower limbs. After laboratory investigations, the doctor has diagnosed the patient with Diabetes Mellitus but failed to specify whether it is type 1 or type 2. Onset of Type 1 diabetes is characterized by:

• A. Occurs after pubertal onset in the majority of cases
• B. Occurs when parents are poor
• C. Occurs at an early age
• D. Occurs after childbirth

Correct answer: A

Rationale: Type 1 diabetes typically occurs after pubertal onset. This form of diabetes is most commonly diagnosed in individuals under the age of 30, with a peak incidence in the mid-teens to early 20s. Puberty is a period of hormonal changes and growth, which can trigger the onset of type 1 diabetes due to the stress it places on the body's insulin-producing cells.

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