Nursing Elites

1. The nurse is having difficulty communicating with a hospitalized 6-year-old child. Which technique should be most helpful?

• A. Recommend that the child keep a diary.
• B. Provide supplies for the child to draw a picture
• C. Suggest that the parent read fairy tales to the child
• D. Ask the parent if the child is always uncommunicative

Correct answer: B

Rationale: Drawing allows the child to express feelings and thoughts non-verbally, which can be particularly effective for children who have difficulty articulating their emotions.

2. Physiologically, the child compensates for fluid volume losses by which mechanism?

• A. Inhibition of aldosterone secretion
• B. Hemoconcentration to reduce cardiac workload
• C. Fluid shift from interstitial space to intravascular space
• D. Vasodilation of peripheral arterioles to increase perfusion

Correct answer: C

Rationale: In response to dehydration, the body compensates by shifting fluids from the interstitial spaces to the intravascular space to maintain blood pressure and perfusion to vital organs. Hemoconcentration and vasoconstriction are other compensatory mechanisms but are less immediate.

3. What are signs and symptoms of a possible kidney transplant rejection in a child? (Select all that apply.)

• A. Fever
• B. Hypotension
• C. All are applicable
• D. Swelling and tenderness of graft area

Correct answer: B

Rationale: Signs of kidney transplant rejection include fever, diminished urinary output, and swelling/tenderness in the graft area. These symptoms indicate that the body may be rejecting the transplanted organ, requiring immediate medical attention.

4. What is the first sign of puberty in boys?

• A. Enlargement of testes
• B. Decreased levels of testosterone
• C. Voice deepening
• D. Pubic hair

Correct answer: A

Rationale: The first sign of puberty in boys is typically the enlargement of the testes. This is due to the increase in production of testosterone, which leads to physical changes such as growth of the testes. Choice B, decreased levels of testosterone, is incorrect as puberty is marked by an increase in testosterone levels. Choice C, voice deepening, and choice D, pubic hair growth, usually occur later in the puberty process compared to testicular enlargement, making them incorrect answers.

5. During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in both eyes. The nurse should recognize that this is which?

• A. A normal finding
• B. A sign of a possible visual defect and a need for vision screening
• C. An abnormal finding requiring referral to an ophthalmologist
• D. A sign of small hemorrhages, which usually resolve spontaneously

Correct answer: A

Rationale: A brilliant, uniform red reflex in both eyes is a normal finding, indicating that the retina is healthy and there are no significant obstructions in the visual pathway.

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