Nursing Elites

1. The nurse is teaching a group of students about myelination in a child. Which statement by the students indicates that the teaching was successful?

• A. Myelination continues into adolescence and beyond.
• B. The process occurs in a cephalocaudal (head-to-toe) pattern.
• C. Myelination decreases the speed of nerve impulses.
• D. Myelination decreases the specificity of nerve impulses.

Correct answer: B

Rationale: The correct answer is B. Myelination occurs in a cephalocaudal (head-to-toe) pattern, improving nerve function progressively. Choice A is incorrect as myelination continues into adolescence and beyond, not just during childhood. Choice C is incorrect because myelination actually increases the speed of nerve impulses rather than decreasing it. Choice D is incorrect as myelination enhances the specificity of nerve impulses, making them more efficient and precise rather than less specific.

2. A parent tells the nurse in the emergency department, 'My 3-year-old has had a fever for several days and has been vomiting.' After instituting ordered measures to reduce the fever, what nursing action is most important?

• A. Preventing shivering
• B. Restricting oral fluids
• C. Measuring output hourly
• D. Taking vital signs hourly

Correct answer: A

Rationale: Preventing shivering is crucial in this scenario as it can increase body temperature and counteract the effects of antipyretic measures aimed at reducing the fever. Shivering generates heat through muscle activity, which can elevate the body temperature. Restricting oral fluids (choice B) is inappropriate as maintaining hydration is vital, especially in cases of fever and vomiting. Measuring output hourly (choice C) and taking vital signs hourly (choice D) are important nursing actions but not the most critical in this case where preventing shivering takes precedence.

3. The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. What would the nurse correlate with the disorder?

• A. The parents report that their child had 'a cold or flu' recently.
• B. Blood pressure is decreased when checking vital signs.
• C. The parents report that their son 'can’t drink enough water.'
• D. Auscultation reveals Kussmaul breathing.

Correct answer: C

Rationale: The correct answer is C. Excessive thirst (polydipsia) is a common symptom of type 2 diabetes mellitus, indicating high blood glucose levels. This symptom occurs due to the body trying to get rid of excess glucose through urine, leading to dehydration and increased thirst. Choices A, B, and D are incorrect. Choice A is more indicative of a recent viral illness rather than a symptom of diabetes. Choice B, decreased blood pressure, is not typically associated with type 2 diabetes; in fact, diabetes can often lead to hypertension. Choice D, Kussmaul breathing, is more characteristic of diabetic ketoacidosis, which is more common in type 1 diabetes rather than type 2 diabetes.

4. A 3-year-old child has a sudden onset of respiratory distress. The mother denies any recent illnesses or fever. You should suspect

• A. croup
• B. epiglottitis
• C. lower respiratory infection
• D. foreign body airway obstruction

Correct answer: D

Rationale: In a 3-year-old child presenting with sudden respiratory distress without fever or recent illness, the most likely cause is a foreign body airway obstruction. Foreign body airway obstruction can lead to a sudden onset of respiratory distress as it blocks the air passage. Croup typically presents with a barking cough and stridor, often preceded by a viral illness. Epiglottitis is characterized by high fever, drooling, and a muffled voice. Lower respiratory infections usually present with symptoms such as cough, fever, and chest congestion. Therefore, in this case, the absence of recent illness or fever makes foreign body airway obstruction the most likely cause of the respiratory distress.

5. At 0345, you receive a call for a woman in labor. Upon arriving at the scene, you are greeted by a very anxious man who tells you that his wife is having her baby 'now.' This man escorts you into the living room where a 25-year-old woman is lying on the couch in obvious pain. After determining that delivery is not imminent, you begin transport. While en route, the mother tells you that she feels the urge to push. You assess her and see the top of the baby's head bulging from the vagina. What is your most appropriate first action?

• A. allow the head to deliver and check for the location of the cord
• B. advise your partner to stop the ambulance and assist with the delivery
• C. tell the mother to take short, quick breaths until you arrive at the hospital
• D. prepare the mother for an emergency delivery and open the obstetrics kit

Correct answer: B

Rationale: The correct action in this scenario is to advise your partner to stop the ambulance and assist with the delivery. When the mother feels the urge to push and you see the baby's head bulging from the vagina, it indicates an imminent delivery. Stopping the ambulance allows for a safer environment for the delivery of the baby and ensures that immediate assistance can be provided to both the mother and the newborn. Allowing the head to deliver before checking for the cord (Choice A) may delay necessary interventions in case of complications. Instructing the mother to take short, quick breaths (Choice C) is not appropriate when the baby's head is already visible. Preparing for an emergency delivery and opening the obstetrics kit (Choice D) is important but should come after stopping the ambulance and assisting with the imminent birth.

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