Nursing Elites

1. The nurse is assessing a 3-year-old boy whose parents brought him to the clinic when they noticed that the right side of his abdomen was swollen. What finding would suggest this child has a neuroblastoma?

• A. The child has a maculopapular rash on his palms.
• B. The parents report that their son is vomiting and not eating well.
• C. The parents report that their son is irritable and not gaining weight.
• D. Auscultation reveals wheezing with diminished lung sounds.

Correct answer: B

Rationale: Vomiting and poor appetite are common symptoms of neuroblastoma, a malignancy that arises from neural crest cells in the adrenal glands or sympathetic nervous system. This tumor can cause abdominal swelling due to its location and size, leading to symptoms like vomiting and decreased appetite. The presence of a maculopapular rash on the palms (Choice A) is not a typical finding associated with neuroblastoma. Irritability and failure to thrive (Choice C) are nonspecific symptoms that can be seen in various conditions but are not specifically indicative of neuroblastoma. Auscultation revealing wheezing with diminished lung sounds (Choice D) may suggest respiratory conditions rather than neuroblastoma.

2. Your assessment of a mother in active labor reveals that a limb is protruding from the vagina. Management of this condition should include:

• A. Positioning the mother in a semi-Fowler's position, administering oxygen, and providing transport
• B. Positioning the mother in a head-down position with her hips elevated, administering oxygen, and providing transport
• C. Applying gentle traction to the protruding limb to remove pressure of the fetus from the umbilical cord
• D. Giving the mother 100% oxygen and attempting to manipulate the protruding limb so that delivery can occur

Correct answer: B

Rationale: In a situation where a limb is protruding from the vagina during active labor, the correct management includes positioning the mother in a head-down position with her hips elevated. This position helps relieve pressure on the umbilical cord and improves oxygenation to the fetus. Administering oxygen is important to ensure adequate oxygen supply to both the mother and the baby. Providing transport is necessary for prompt transfer to a medical facility for further management. Applying gentle traction to the protruding limb is not recommended as it can cause harm to the baby and should be avoided. Giving 100% oxygen and attempting to manipulate the protruding limb is not the correct approach and can potentially lead to further complications.

3. The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. What symptom would the nurse correlate with the disorder?

• A. The parents report that their child had a recent 'cold or flu.'
• B. Blood pressure is decreased during vital signs assessment.
• C. The parents report that their son 'can’t drink enough water.'
• D. Auscultation reveals Kussmaul breathing.

Correct answer: C

Rationale: The correct answer is C. In type 2 diabetes mellitus, excessive thirst (polydipsia) is a common symptom due to high blood glucose levels. This results in the patient feeling unable to drink enough water to satisfy their thirst. The other options are incorrect because a recent 'cold or flu' (choice A) is not directly related to diabetes mellitus, decreased blood pressure (choice B) is not a typical finding in uncontrolled diabetes, and Kussmaul breathing (choice D) is associated with diabetic ketoacidosis, which is more common in type 1 diabetes mellitus.

4. A child who had surgery for a congenital heart defect is being discharged. What is an important aspect of the discharge teaching?

• A. Teaching the parents about signs of infection
• B. Providing instructions on wound care
• C. Scheduling follow-up appointments
• D. Explaining the use of prescribed medications

Correct answer: D

Rationale: Explaining the use of prescribed medications is crucial as it helps ensure the proper management of the child's condition post-discharge. Understanding how and when to administer medications is essential for the child's recovery. While teaching the parents about signs of infection, providing wound care instructions, and scheduling follow-up appointments are also important aspects of care, ensuring the correct use of prescribed medications takes precedence to prevent complications and promote the child's well-being.

5. A 2-year-old child with a diagnosis of hemophilia is admitted to the hospital. What should the nurse include in the care plan?

• A. Encourage participation in contact sports
• B. Use a soft toothbrush for oral care
• C. Administer nonsteroidal anti-inflammatory drugs
• D. Administer aspirin for pain

Correct answer: B

Rationale: The correct answer is to use a soft toothbrush for oral care. Children with hemophilia have a decreased ability to form blood clots, leading to prolonged bleeding. Using a soft toothbrush helps prevent trauma to the gums and oral mucosa, reducing the risk of bleeding. Encouraging participation in contact sports (Choice A) is contraindicated in hemophiliac patients due to the high risk of injury and bleeding. Administering nonsteroidal anti-inflammatory drugs (Choice C) and aspirin (Choice D) should be avoided in hemophilia as they can further increase the risk of bleeding due to their antiplatelet effects.

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