Nursing Elites

1. The nurse is caring for a 4-year-old child with a greenstick fracture. In explaining this type of fracture to the parents, the best response by the nurse should be that

• A. A child's bone is more flexible and can be bent 45 degrees before breaking
• B. Bones of children are more porous than adults and often have incomplete breaks
• C. Compression of porous bones produces a buckle or torus type break
• D. Bone fragments often remain attached by a periosteal hinge

Correct answer: B

Rationale: The correct answer is B. Greenstick fractures are common in children because their bones are softer and more porous than adult bones, leading to incomplete breaks when force is applied. Choice A is incorrect as greenstick fractures are not due to bone flexibility but rather the porous nature of children's bones. Choice C is incorrect as it describes a buckle or torus type break, which is not characteristic of a greenstick fracture. Choice D is incorrect as greenstick fractures do not involve bone fragments remaining attached by a periosteal hinge.

2. An infant has just returned from surgery for placement of a gastrostomy tube as an initial treatment for tracheoesophageal fistula. The mother asks, 'When can the tube be used for feeding?' The nurse's best response would be which of these comments?

• A. "Feedings can begin in 5 to 7 days."
• B. "The use of the feeding tube can begin immediately."
• C. "The stomach contents and air must be drained first."
• D. "The incision healing must be complete before feeding."

Correct answer: C

Rationale: The correct answer is C: 'The stomach contents and air must be drained first.' Before starting feedings through a gastrostomy tube, it is essential to drain the stomach contents and air. This process helps prevent complications and ensures the proper functioning of the tube after placement. Choice A is incorrect because initiating feedings within 5 to 7 days may lead to complications if the stomach is not adequately prepared. Choice B is incorrect as feeding should not begin immediately to allow for proper preparation of the tube and the stomach. Choice D is incorrect because although incision healing is important, draining the stomach contents and air is a more immediate concern to prevent complications.

3. A school nurse is assessing a child who has frequent absences from school due to asthma. Which of the following is the priority nursing action?

• A. Teaching the child how to use an inhaler
• B. Assessing the child's asthma management plan
• C. Discussing the importance of school attendance with the parents
• D. Referring the child to a pulmonologist

Correct answer: B

Rationale: The correct answer is to assess the child's asthma management plan. This is the priority action as it allows the nurse to evaluate the current treatment regimen, identify any gaps or areas for improvement, and ensure that the plan is being effectively implemented. Teaching the child how to use an inhaler (Choice A) may be important but should come after assessing the management plan. Discussing the importance of school attendance with the parents (Choice C) is secondary to ensuring proper asthma management. Referring the child to a pulmonologist (Choice D) may be necessary but is not the priority at this stage; first, the nurse needs to evaluate the current plan in place.

4. The nurse is caring for a 5-year-old child who has the left leg in skeletal traction. Which of the following activities would be an appropriate diversional activity?

• A. Kicking balloons with the right leg
• B. Playing 'Simon Says'
• C. Playing handheld games
• D. Throwing bean bags

Correct answer: C

Rationale: Playing handheld games is an appropriate diversional activity for a child in skeletal traction because it does not require physical movement of the affected limb. This activity can help keep the child entertained and engaged without risking any harm to the tractioned leg. Choices A, B, and D involve physical movements that could potentially interfere with the skeletal traction or cause discomfort to the child.

5. A client has been admitted for meningitis. In reviewing the laboratory analysis of cerebrospinal fluid (CSF), the nurse would expect to note

• A. High protein
• B. Clear color
• C. Elevated sed rate
• D. Increased glucose

Correct answer: A

Rationale: High protein levels in the cerebrospinal fluid are indicative of bacterial meningitis, as the presence of bacteria in the CSF leads to increased protein production. Elevated protein levels can be seen in inflammatory conditions like meningitis. Choice B, clear color, is not expected in meningitis as it is typically associated with cloudy or turbid CSF. Elevated sed rate (choice C) and increased glucose (choice D) are not typically associated with the laboratory findings seen in meningitis.

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