Nursing Elites

1. The healthcare provider is caring for a child on bed rest who has severe edema in the left lower extremity due to blocked lymphatic drainage. Which nursing diagnosis would take priority?

• A. Risk for Impaired Skin Integrity
• B. Risk for Altered Body Image
• C. Risk for Imbalanced Nutrition: Less Than Body Requirements
• D. Risk for Activity Intolerance

Correct answer: A

Rationale: The priority nursing diagnosis in this scenario is 'Risk for Impaired Skin Integrity' because severe edema in the left lower extremity can lead to compromised circulation and pressure ulcers, increasing the risk of skin breakdown and infection. Addressing and preventing impaired skin integrity is crucial for the child's overall health and well-being.

2. When preparing an adolescent for a lumbar puncture, which of the following actions should the nurse take?

• A. Place a cardiac monitor on the adolescent prior to the procedure
• B. Apply topical analgesic cream to the site one hour prior to the procedure
• C. Keep the adolescent in a semi-Fowler's position for 4 hours following the procedure
• D. Restrict fluids for 2 hours following the procedure

Correct answer: B

Rationale: The correct action for the nurse when preparing an adolescent for a lumbar puncture is to apply topical analgesic cream to the site one hour before the procedure. This helps reduce pain experienced during the lumbar puncture, making the procedure more comfortable for the adolescent. Placing a cardiac monitor on the adolescent is not necessary for a lumbar puncture. Keeping the adolescent in a semi-Fowler's position for 4 hours following the procedure is not a standard practice after a lumbar puncture. Restricting fluids for 2 hours following the procedure is not a requirement for a lumbar puncture preparation.

3. How should professionals communicate with parents and family members?

• A. Share information with both parents to distribute the stress equally
• B. Share information with one parent to ensure accuracy
• C. Share information with all individuals who interact with the child, whether family or not
• D. Provide information in writing exclusively to ensure clear communication

Correct answer: C

Rationale: When professionals communicate with parents and family members, it is essential to share information with all individuals who interact with the child, whether they are family members or not. This inclusive approach ensures that everyone involved in the child's care and well-being is well-informed and can provide support as needed. It is important to consider the broader network of individuals who play a role in the child's life to promote comprehensive and effective communication.

4. A neonate with a meningomyelocele is scheduled for surgery in the morning. Which nursing action is appropriate for this neonate?

• A. Applying a diaper to prevent contamination of the sac
• B. Positioning the newborn in a side-lying position
• C. Encouraging the mother to hold the newborn because she will not be able to pick him up after surgery
• D. Positioning the newborn in a prone position

Correct answer: D

Rationale: Positioning the newborn in a prone position is appropriate for a neonate with a meningomyelocele before surgery. Placing the newborn in this position helps prevent pressure on the sac, reducing the risk of damaging it and promoting optimal surgical outcomes. Applying a diaper (choice A) may not be recommended as it can increase pressure on the sac. Positioning the newborn in a side-lying position (choice B) or encouraging the mother to hold the newborn (choice C) are not ideal actions before surgery as they do not address the specific needs of a neonate with a meningomyelocele.

5. What is it called when the therapist adjusts the difficulty level of an activity to match the child's abilities by bringing a toy closer for them to successfully reach and grasp during therapy?

• A. Compensating
• B. Adapting
• C. Grading
• D. Modifying

Correct answer: C

Rationale: The correct answer is C: Grading. Grading involves adjusting the difficulty level of an activity to match the child's abilities. Bringing a toy closer for easier reach is an example of grading in therapy, helping the child succeed in reaching and grasping the toy within their current capabilities. Choice A, Compensating, implies making up for a deficit, which is not the case here. Choice B, Adapting, suggests changing the activity itself, not just the difficulty level. Choice D, Modifying, indicates altering the toy or the task itself, rather than adjusting the task's difficulty level.

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