Nursing Elites

1. The caregiver is caring for an infant with osteogenesis imperfecta and is providing instruction on how to reduce the risk of injury. Which response from the caregiver indicates a need for further teaching?

• A. I need to avoid pushing or pulling on an arm or leg.
• B. I should carefully lift the baby by supporting the head and neck.
• C. I should not bend an arm or leg into an awkward position.
• D. We must avoid lifting the legs by the ankles to change diapers.

Correct answer: B

Rationale: Lifting the baby by supporting the head and neck can cause fractures in infants with osteogenesis imperfecta. Caregivers should avoid lifting infants in this manner due to the risk of injury. Choices A, C, and D demonstrate correct understanding of how to prevent injuries in infants with osteogenesis imperfecta by avoiding excessive force on the arms or legs, preventing awkward positions, and lifting the legs in a safer manner to change diapers.

2. While assessing an 18-month-old child, a nurse observes that the toddler can crawl upstairs but needs assistance when climbing the stairs upright. What does this action indicate to the nurse?

• A. Presence of talipes equinovarus
• B. Reflective of neurologic damage
• C. Expected behavior in a toddler of this age
• D. Existence of developmental dysplasia of the hip

Correct answer: C

Rationale: At 18 months of age, needing assistance to climb stairs upright is considered normal behavior for a toddler. Crawling upstairs is a different motor skill and does not necessarily correlate with the ability to climb stairs. The child is still developing gross motor skills, and climbing stairs upright typically requires more coordination and strength, which may not be fully developed at this age. Choices A, B, and D are not relevant in this scenario as the observed behavior is within the expected range of development for an 18-month-old child.

3. A parent receives a note from the school that a student in class has head lice. The parent calls the school nurse to ask how to check for head lice. What instructions should the nurse provide?

• A. Ask the child where it itches.
• B. Check to see if your dog has ear mites.
• C. Look along the scalp line for white dots.
• D. Observe between the fingers for red lines.

Correct answer: C

Rationale: The correct answer is to look along the scalp line for white dots (nits) when checking for head lice. White dots/nits are the eggs of head lice and are commonly found attached to the hair shaft near the scalp. This method helps identify if head lice are present. Choice A is incorrect as itching alone may not be a definitive sign of head lice; it could be due to other reasons. Choice B is irrelevant as ear mites in dogs are not related to head lice infestation in humans. Choice D is also incorrect as observing between the fingers for red lines is not a method for checking head lice.

4. A 7-year-old child has an altered mental status, high fever, and a generalized rash. You perform your assessment and initiate oxygen therapy. En route to the hospital, you should be most alert for

• A. vomiting
• B. seizures
• C. combativeness
• D. respiratory distress

Correct answer: B

Rationale: Seizures are a common complication in children with high fever and altered mental status, indicating a risk of febrile seizures. While vomiting can occur with altered mental status, seizures are of higher concern due to the association with febrile illnesses in children. Combativeness may be a concern in some altered mental status cases but is not as common as seizures. Respiratory distress, although important, is not the primary concern in this scenario given the symptoms presented.

5. A nurse is caring for an infant with intractable vomiting. For what complication is it most important for the nurse to assess?

• A. Acidosis
• B. Alkalosis
• C. Hyperkalemia
• D. Hypernatremia

Correct answer: B

Rationale: When an infant experiences intractable vomiting, it can lead to the loss of stomach acids, resulting in metabolic alkalosis. Alkalosis is characterized by elevated blood pH and can lead to serious complications. Assessing for alkalosis is essential in this scenario to monitor and manage the infant's condition. Choices A, C, and D are incorrect because in this context, the primary concern is the metabolic imbalance caused by excessive vomiting, leading to alkalosis rather than acidosis, hyperkalemia, or hypernatremia.

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