Nursing Elites

1. The father is being taught by a nurse how to stimulate his 7-year-old son who has a 'slow-to-warm-up' temperament. Which guidance will be most successful?

• A. Telling him to read stories to the child about famous athletes
• B. Suggesting he take the child to watch him play softball
• C. Urging him to sign the child up for little league football
• D. Proposing wrestling with the child and letting him win

Correct answer: A

Rationale: For a child with a 'slow-to-warm-up' temperament, it is important to choose activities that are less intense and allow for gradual engagement. Reading stories to the child about famous athletes would be the most successful approach as it is less active and more likely to be acceptable to the child's temperament. Choice B and C involve more active and potentially overwhelming activities, which may not suit the child's temperament. Choice D, proposing wrestling and letting the child win, might create a competitive environment that could be counterproductive for a 'slow-to-warm-up' child.

2. A nurse is caring for a 7-year-old child with a diagnosis of type 1 diabetes mellitus. What is the priority nursing intervention?

• A. Administering insulin as prescribed
• B. Monitoring blood glucose levels
• C. Teaching the child how to self-administer insulin
• D. Encouraging regular exercise

Correct answer: B

Rationale: The priority nursing intervention for a 7-year-old child with type 1 diabetes mellitus is to monitor blood glucose levels. This is crucial for managing and adjusting insulin therapy effectively. Administering insulin as prescribed is important, but monitoring blood glucose levels takes precedence as it guides insulin administration. Teaching the child how to self-administer insulin and encouraging regular exercise are also important aspects of diabetes management, but they are not the priority in this situation.

3. A child with a diagnosis of diabetes insipidus is admitted to the hospital. What is the priority nursing intervention?

• A. Administering insulin
• B. Monitoring fluid balance
• C. Administering diuretics
• D. Monitoring vital signs

Correct answer: B

Rationale: The correct priority nursing intervention for a child diagnosed with diabetes insipidus is to monitor fluid balance. Diabetes insipidus is a condition characterized by excessive urination and thirst, which can lead to dehydration. Monitoring fluid balance is essential to prevent dehydration and ensure the child's hydration status remains stable. Administering insulin (Choice A) is not indicated in diabetes insipidus because it is a disorder of the posterior pituitary gland, not the pancreas. Administering diuretics (Choice C) would exacerbate fluid loss in a child already at risk for dehydration. Monitoring vital signs (Choice D) is important but not the priority when compared to maintaining fluid balance in a child with diabetes insipidus.

4. A group of students is reviewing information about the endocrine system in infants and children. The students demonstrate understanding of the information when they state:

• A. Endocrine glands begin developing in the first trimester of gestation.
• B. At birth, the endocrine glands are not fully functional.
• C. Infants may have difficulty balancing glucose and electrolytes.
• D. A child’s endocrine system plays a vital role in growth and development.

Correct answer: C

Rationale: The correct statement is that infants may have difficulty balancing glucose and electrolytes because their endocrine systems are immature. Newborns have developing endocrine glands that are not yet fully functional, leading to challenges in maintaining glucose and electrolyte balance. Choice A is incorrect as endocrine glands start developing in the first trimester, not the third trimester. Choice B is incorrect as endocrine glands are not fully functional at birth. Choice D is incorrect because while a child’s endocrine system indeed plays a vital role in growth and development, the specific focus of the question is on the challenges infants face due to immature endocrine glands.

5. A 4-year-old fell from a third-story window and landed on her head. She is semiconscious with slow, irregular breathing and bleeding from her mouth. After performing a jaw-thrust maneuver with simultaneous stabilization of her head, what should you do next?

• A. Suction the oropharynx
• B. Insert a nasopharyngeal airway
• C. Initiate positive pressure ventilations
• D. Administer oxygen via mask

Correct answer: A

Rationale: In this scenario, the patient is experiencing airway compromise due to the fall and potential oropharyngeal obstruction from bleeding. Performing a jaw-thrust maneuver with head stabilization helps maintain the airway patency. The next step should be to suction the oropharynx to clear any blood or secretions, which can obstruct the airway and lead to aspiration. Inserting a nasopharyngeal airway may worsen bleeding or cause further injury to the patient's airway. Initiating positive pressure ventilations can be ineffective if the airway is not cleared first. Administering oxygen via mask is not the immediate priority; ensuring a patent airway by suctioning takes precedence.

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