Nursing Elites

1. The parents of a 1-month-old girl with Down syndrome are being taught by the nurse on how to maintain the child's good health. Which instruction would the nurse be least likely to include?

• A. Getting cervical radiographs between 3 and 5 years of age
• B. Adhering to the special dietary needs of the child
• C. Getting an echocardiogram before 3 months of age
• D. Monitoring for symptoms of respiratory infection

Correct answer: B

Rationale: The correct answer is B. While special dietary needs may be important, they are not typically a primary concern for a 1-month-old with Down syndrome compared to monitoring for congenital issues. Getting cervical radiographs, an echocardiogram, and monitoring for respiratory infections are more crucial in the early care of a child with Down syndrome. Cervical radiographs help in assessing for atlantoaxial instability, an echocardiogram is important for detecting congenital heart defects common in Down syndrome, and monitoring for respiratory infections is vital due to the increased risk in these children.

2. A child with a diagnosis of nephrotic syndrome is being discharged. What dietary instructions should the nurse provide?

• A. Encourage a high-protein diet
• B. Avoid foods high in salt
• C. Encourage a low-sodium diet
• D. Encourage a low-protein diet

Correct answer: B

Rationale: For a child with nephrotic syndrome, it is crucial to avoid foods high in salt to manage symptoms and prevent complications. Excessive salt intake can lead to fluid retention and exacerbate edema, which are common issues in nephrotic syndrome. Encouraging a high-protein diet (Choice A) may put additional strain on the kidneys and worsen the condition. While protein restriction is sometimes needed, it is not the primary dietary concern in nephrotic syndrome. Similarly, a low-protein diet (Choice D) is not typically recommended as it may lead to malnutrition in children. Although a low-sodium diet (Choice C) may sound similar to avoiding foods high in salt, the emphasis should be on reducing salt intake specifically, rather than a generalized low-sodium approach.

3. When explaining a viral disease that begins with malaise and a highly pruritic rash starting on the abdomen, spreading to the face and proximal extremities, and potentially leading to severe complications, which childhood disease is a nurse discussing with members of a grammar school’s Parent-Teachers Association?

• A. Rubella
• B. Rubeola
• C. Chickenpox
• D. Scarlet fever

Correct answer: C

Rationale: The correct answer is Chickenpox (varicella). This viral disease typically starts with malaise and a highly pruritic rash that begins on the abdomen and then spreads to the face and proximal extremities. Chickenpox can result in serious complications such as pneumonia and encephalitis. Rubella (German measles) presents with a milder rash and is less pruritic than chickenpox. Rubeola (measles) is characterized by a rash that spreads from the head to the trunk. Scarlet fever is caused by group A Streptococcus bacteria and is not a viral illness.

4. A nurse is planning an evening snack for a child receiving Novolin N insulin. What is the reason for this nursing action?

• A. To encourage the child to stay on the diet.
• B. Energy is needed for immediate utilization.
• C. Extra calories will help the child gain weight.
• D. Nourishment helps to counteract late insulin activity.

Correct answer: D

Rationale: The correct answer is D. Novolin N insulin peaks in the evening, leading to a higher risk of hypoglycemia during this time. Providing a snack before bedtime helps counteract the late insulin activity and prevent hypoglycemia. Choice A is incorrect as the primary reason for the snack is related to insulin activity rather than diet compliance. Choice B is not directly related to the timing of Novolin N insulin administration. Choice C is unrelated to the specific need for a snack in the evening to address insulin activity.

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. The woman states that her contractions are occurring every 4 to 5 minutes and lasting approximately 30 seconds each. Which of the following questions would be most appropriate to ask at this point?

• A. Has your bag of waters broken yet?
• B. Have you had regular prenatal care?
• C. At how many weeks gestation are you?
• D. How many other children do you have?

Correct answer: C

Rationale: In this scenario, asking about the gestational age is crucial as it helps determine the stage of labor and potential complications. Knowing the number of weeks of gestation can guide the healthcare provider in assessing the progress of labor and making decisions about the care of both the mother and the baby. Choices A, B, and D are not as relevant in this urgent situation. While knowing if the bag of waters has broken is important for assessing the progress of labor, determining gestational age is more critical at this point. Asking about regular prenatal care or the number of other children does not provide immediate information necessary for managing the current situation.

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