Nursing Elites

1. In a well-child clinic, the nurse examines many children daily. Which of the following toddlers requires further follow-up?

• A. A 13-month-old who is unable to walk
• B. A 20-month-old who is only using 2 and 3 word sentences
• C. A 24-month-old who cries during examination
• D. A 30-month-old who is only drinking from a sip cup

Correct answer: D

Rationale: The correct answer is D because a 30-month-old should have developed the skill to drink from a regular cup by this age. Drinking from a sip cup at this stage may indicate a delay in development. Choices A, B, and C are not as concerning as they can be within the range of normal development. A 13-month-old not walking yet, a 20-month-old using 2 and 3 word sentences, and a 24-month-old crying during examination are all behaviors that can fall within the spectrum of typical development for their respective ages.

2. The nurse uses the DRG (Diagnosis Related Group) manual to

• A. Classify nursing diagnoses from the client's health history
• B. Identify findings related to a medical diagnosis
• C. Determine reimbursement for a medical diagnosis
• D. Implement nursing care based on case management protocol

Correct answer: C

Rationale: The DRG manual is used to determine the reimbursement rate for medical diagnoses and treatments under the prospective payment system used by healthcare facilities. Choice A is incorrect because the DRG manual is not used to classify nursing diagnoses, but rather to group medical diagnoses for billing purposes. Choice B is incorrect as the DRG manual is not used to identify findings related to medical diagnoses, but rather to standardize payments for medical services. Choice D is incorrect as the DRG manual is not used to implement nursing care based on case management protocol, but rather to set reimbursement rates.

3. What title should be given to this professional role in occupational health? A registered nurse who develops researchable questions, conducts research, and communicates the findings to occupational and environmental health professionals, other peers, and the public.

• A. manager
• B. researcher
• C. clinician/practitioner
• D. health promotion specialist

Correct answer: B

Rationale: The correct answer is 'B: researcher.' In this context, the individual is primarily involved in developing research questions, conducting research, and disseminating findings, which aligns with the responsibilities of a researcher. Choice 'A: manager' is incorrect because the role described does not primarily involve managerial duties. Choice 'C: clinician/practitioner' is also incorrect as the focus is on research activities rather than direct clinical practice. Choice 'D: health promotion specialist' does not encompass the full scope of responsibilities described in the scenario.

4. The RN is planning care at a team meeting for a 2-month-old child in bilateral leg casts for congenital clubfoot. Which of these suggestions by the PN should be considered the priority nursing goal following cast application?

• A. Infant will experience minimal pain
• B. Muscle spasms will be relieved
• C. Mobility will be managed as tolerated
• D. Tissue perfusion will be maintained

Correct answer: D

Rationale: Following cast application for congenital clubfoot in a 2-month-old child, the priority nursing goal should be to maintain tissue perfusion. This is crucial to prevent complications like compartment syndrome and ensure proper healing. While managing pain, relieving muscle spasms, and promoting mobility are important aspects of care, they are secondary to ensuring adequate tissue perfusion in this scenario.

5. A home health nurse is at the home of a client with diabetes and arthritis. The client has difficulty drawing up insulin. It would be most appropriate for the nurse to refer the client to:

• A. A social worker from the local hospital
• B. An occupational therapist from the community center
• C. A physical therapist from the rehabilitation agency
• D. Another client with diabetes mellitus who takes insulin

Correct answer: B

Rationale: An occupational therapist is the most appropriate professional to refer the client to in this situation. Occupational therapists can provide assistance with techniques and tools to help the client manage insulin administration despite arthritis. Referring the client to a social worker (Choice A) may not directly address the client's difficulty with insulin. While physical therapists (Choice C) focus on mobility and strength, they may not specialize in techniques for insulin administration. Referring the client to another client with diabetes (Choice D) is not a professional or appropriate solution to address the client's difficulty.

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