Nursing Elites

1. What is important to include in discharge instructions for parents of a child who has had a tonsillectomy?

• A. Encourage the child to gargle with salt water
• B. Encourage fluid intake
• C. Provide the child with hard candy
• D. Apply heat to the neck

Correct answer: B

Rationale: Encouraging fluid intake is essential in the discharge instructions for a child who has had a tonsillectomy. It helps keep the throat moist, aids in preventing dehydration, and promotes healing. Gargling with salt water is not typically recommended after a tonsillectomy as it may irritate the surgical site. Providing the child with hard candy is not advisable as it can irritate the throat and potentially cause harm. Applying heat to the neck is also not recommended post-tonsillectomy as it can increase swelling and discomfort in the surgical area.

2. A child sitting on a chair in a playroom starts to have a tonic-clonic seizure with a clenched jaw. What is the nurse’s best initial action?

• A. Attempt to open the jaw.
• B. Place the child on the floor.
• C. Call out for assistance from staff.
• D. Place a pillow under the child’s head.

Correct answer: B

Rationale: The best initial action during a tonic-clonic seizure is to place the child on the floor. This action helps prevent injury by providing a safe environment and allows for better management of the seizure episode. Attempting to open the jaw is not recommended as it may cause harm to the child or the nurse. Calling out for assistance is important but should not delay ensuring the child's safety first. Placing a pillow under the child's head is not advisable during a seizure as it can pose a risk of suffocation or choking.

3. The nurse is assessing a family to determine if they have access to adequate health care. Which statement accurately describes how certain families are affected by common barriers to health care?

• A. After a decade of escalation, the percentage of children living in low-income families has been on the decline since 2000.
• B. White, non-Hispanic children overall are more likely than African American and Hispanic children to be in very good or excellent health.
• C. The proportion of children between the ages of 6 and 18 who are overweight is decreasing, but a large increase is occurring in African American females.
• D. The overall health care plan of working families may improve access to specialty care but limit access to preventive services.

Correct answer: B

Rationale: Choice B is the correct answer because it accurately states that White, non-Hispanic children are more likely to be in very good or excellent health compared to African American and Hispanic children. This reflects a disparity in health outcomes among different racial groups. Choices A, C, and D are incorrect. Choice A is unrelated to the impact of common barriers to health care on families. Choice C talks about overweight children but does not address access to health care. Choice D discusses the impact of the overall health care plan on working families but does not specifically address the disparity in health status among different racial groups.

4. When caring for a 2-year-old girl who is wheezing and has difficulty breathing, which interview question would provide the most useful information related to the symptoms of the child?

• A. Inquiring about child safety in the home
• B. Asking about the temperament of the child
• C. Asking about the child's diet
• D. Asking the parents if they smoke in the home

Correct answer: D

Rationale: Asking the parents if they smoke in the home is the most relevant question as exposure to secondhand smoke can exacerbate respiratory symptoms like wheezing and difficulty breathing in children. Smoking indoors can worsen the child's condition and is crucial information for the healthcare provider to assess and address. Inquiring about child safety in the home, asking about the child's temperament, and questioning the child's diet are important aspects of care but are not directly linked to the immediate respiratory symptoms the child is experiencing.

5. Which cardiac defects are associated with tetralogy of Fallot?

• A. Right ventricular hypertrophy, atrial and ventricular defects, and mitral valve stenosis
• B. Origin of the aorta from the right ventricle and of the pulmonary artery from the left ventricle
• C. Right ventricular hypertrophy, ventricular septal defect, pulmonic stenosis, and overriding aorta
• D. Altered connection between the pulmonary artery and the aorta, right ventricular hypertrophy, and an atrial septal defect

Correct answer: C

Rationale: Tetralogy of Fallot is characterized by a combination of four specific cardiac defects: right ventricular hypertrophy, ventricular septal defect, pulmonic stenosis, and overriding aorta. Choice A is incorrect as it includes mitral valve stenosis, which is not typically part of tetralogy of Fallot. Choice B describes transposition of the great arteries rather than tetralogy of Fallot. Choice D includes an atrial septal defect, which is not part of the classic presentation of tetralogy of Fallot.

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