Nursing Elites

1. The clinic nurse is reviewing the immunization guidelines for hepatitis B. Which are true of the guidelines for this vaccine?

• A. The hepatitis B vaccination series should be begun at birth
• B. All are applicable
• C. Any child not vaccinated at birth should receive two doses at least 4 months apart
• D. An unimmunized 10-year-old child should receive three doses administered 4 weeks apart

Correct answer: B

Rationale: Hepatitis B vaccination should start at birth, and any child or adolescent not vaccinated should complete the series. Adolescents should receive three doses if they were not previously vaccinated.

2. When assessing a child with chronic renal failure, which clinical manifestations would the nurse expect to find?

• A. Uremic frost
• B. Hypotension
• C. Massive hematuria
• D. Severe metabolic acidosis

Correct answer: A

Rationale: When assessing a child with chronic renal failure, the nurse would expect to find uremic frost as a clinical manifestation. Uremic frost, a white powdery deposit of urea on the skin, occurs in severe cases of chronic renal failure due to the accumulation of urea and other waste products in the blood. Hypotension and massive hematuria are less common in chronic renal failure, while severe metabolic acidosis is typically mild to moderate and not a prominent clinical manifestation.

3. Which condition is characterized by a "barking" cough in children?

• A. Asthma
• B. Bronchiolitis
• C. Croup
• D. Pneumonia

Correct answer: C

Rationale: Croup is the correct answer. It is characterized by a distinctive "barking" cough, typically worse at night, caused by the inflammation of the upper airway, specifically the larynx and trachea. Asthma (Choice A) typically presents with wheezing and shortness of breath rather than a barking cough. Bronchiolitis (Choice B) commonly causes wheezing and respiratory distress in infants and young children. Pneumonia (Choice D) often presents with symptoms like fever, productive cough, and chest pain, but not typically a barking cough.

4. What signs and symptoms are indicative of a urinary tract disorder in the infancy period (1-24 months)? (Select all that apply.)

• A. All below
• B. Poor feeding
• C. Hypothermia
• D. Frequent urination

Correct answer: A

Rationale: In infants, urinary tract disorders may present with poor feeding, hypothermia, and frequent urination. Pallor can be associated with other conditions but is less specific to urinary tract disorders.

5. A 14-year-old with chronic renal failure suddenly becomes non-compliant with the medication regimen. Which nursing intervention would most likely improve compliance?

• A. Give the child a computer-animated game that presents information on the management of chronic renal failure.
• B. Set up a meeting with some older teens who have chronic renal failure and have been managing their disease effectively.
• C. Arrange for a physician to sit down and talk to the child about the risks related to noncompliance with medications.
• D. Discuss with the child’s parents that privileges, such as a cell phone, can be taken away if compliance fails to improve.

Correct answer: B

Rationale: Adolescents often seek guidance and support from their peers. Setting up a meeting with older teens who are effectively managing chronic renal failure can provide the 14-year-old with motivation, encouragement, and practical advice on how to handle their treatment regimen. This peer support can positively influence the non-compliant adolescent, making choice B the most likely intervention to improve compliance. Choices A and C may not address the peer influence aspect of adolescent behavior, while choice D focuses on punitive measures rather than addressing the underlying reasons for non-compliance.

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