Nursing Elites

1. The parents of a 2-year-old child tell the nurse that they are having difficulty disciplining their child. What is the nurse’s most appropriate response?

• A. “This is a difficult age that your child is going through right now.”
• B. “Tell me more about your difficulty. I’m not sure what you mean by this.”
• C. “It’s important to be consistent with toddlers when they need disciplining.”
• D. “I can understand what you mean. That’s why this age is called the terrible twos.”

Correct answer: C

Rationale: The most appropriate response for the nurse is to emphasize the importance of consistency in discipline when dealing with toddlers. Toddlers are at an age where they are learning boundaries and acceptable behaviors. By being consistent, parents can help their child understand what is expected of them and establish a sense of structure and routine. Choices A, B, and D do not provide constructive advice or guidance on how to address the issue of disciplining a 2-year-old. Choice A merely acknowledges the age without providing guidance, choice B seeks more information without offering support, and choice D labels the age without offering practical advice on discipline.

2. A healthcare provider is assessing a child with suspected bacterial meningitis. What clinical manifestation is the healthcare provider likely to observe?

• A. Photophobia
• B. High fever
• C. Rash
• D. Nasal congestion

Correct answer: B

Rationale: High fever is a key clinical manifestation of bacterial meningitis due to the inflammatory response in the meninges. Photophobia, choice A, is also commonly observed due to meningeal irritation, but it is not as specific as high fever. Rash, choice C, is more indicative of conditions like meningococcal meningitis rather than bacterial meningitis. Nasal congestion, choice D, is not typically associated with bacterial meningitis. Therefore, the correct answer is B.

3. A nurse is assessing a child with suspected rheumatic fever. What clinical manifestation is the nurse likely to observe?

• A. Jaundice
• B. Peeling skin on the hands and feet
• C. High fever
• D. Severe joint pain

Correct answer: D

Rationale: The correct answer is D, severe joint pain. Rheumatic fever commonly presents with severe joint pain due to joint inflammation. Jaundice (choice A) is not typically associated with rheumatic fever. Peeling skin on the hands and feet (choice B) is more indicative of conditions like Kawasaki disease. While a high fever (choice C) can be present, it is not as specific to rheumatic fever as severe joint pain. Severe joint pain, along with other criteria like carditis, subcutaneous nodules, erythema marginatum, and Sydenham chorea, are major criteria used in the diagnosis of rheumatic fever.

4. A child has been diagnosed with classic hemophilia. A nurse teaches the child’s parents how to administer the plasma component factor VIII through a venous port. It is to be given 3 times a week. What should the nurse tell them about when to administer this therapy?

• A. Whenever a bleed is suspected
• B. In the morning on scheduled days
• C. At bedtime while the child is lying quietly in bed
• D. On a regular schedule at the parents’ convenience

Correct answer: B

Rationale: Administering factor VIII in the morning on scheduled days ensures that there is a consistent level of the plasma component throughout the day, especially when the child is active. This timing helps to maintain adequate levels of factor VIII to prevent bleeding episodes. Choice A is incorrect because administering factor VIII only when a bleed is suspected would not provide the consistent prophylactic coverage needed for children with hemophilia. Choice C is incorrect as bedtime administration may not be practical for ensuring the plasma component is available during the child's active hours. Choice D is incorrect because administering factor VIII on a regular schedule, rather than at specific times of the day, may not optimize its effectiveness in preventing bleeding episodes.

5. The nurse closely monitors the temperature of a child with minimal change nephrotic syndrome. The purpose of this assessment is to detect an early sign of which possible complication?

• A. infection
• B. hypertension
• C. encephalopathy
• D. edema

Correct answer: A

Rationale: Monitoring the temperature of a child with minimal change nephrotic syndrome is crucial to detect early signs of infection. Infection is a common complication in nephrotic syndrome, and fever can be an early indicator. Hypertension (choice B) is not typically associated with nephrotic syndrome. Encephalopathy (choice C) is a neurological complication and would present with altered mental status rather than a change in temperature. Edema (choice D) is a common symptom of nephrotic syndrome but is not typically monitored through temperature assessment.

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