Nursing Elites

1. What information should the nurse provide to parents of a 3-year-old boy with Duchenne muscular dystrophy who inquire about the disease and future children?

• A. This is an inherited X-linked recessive disorder, which primarily affects male children in the family
• B. The striated muscle groups of males can be impacted by a lack of the protein dystrophin in their mothers
• C. The male infant had a viral infection that went unnoticed and untreated so muscle damage was incurred
• D. Birth trauma with a breech vaginal birth causes damage to the spinal cord, thus weakening the muscles

Correct answer: A

Rationale: Duchenne muscular dystrophy is an X-linked recessive disorder caused by mutations in the DMD gene on the X chromosome. This disorder primarily affects males because they have one X chromosome, inherited from their mothers, who may be carriers of the mutated gene. Females have two X chromosomes, providing a protective effect as the normal gene on one X chromosome can compensate for the mutated gene on the other. Therefore, the nurse should explain to the parents that Duchenne muscular dystrophy is an inherited X-linked recessive disorder, which is why their son has the disease and why there is a risk of passing it on to future sons. Choice B is incorrect as it inaccurately implies that the lack of dystrophin in mothers impacts their sons' muscle groups. Choice C is incorrect as it suggests a viral infection caused the muscle damage, which is not the case with Duchenne muscular dystrophy. Choice D is incorrect as it attributes the muscle weakness to birth trauma instead of the genetic nature of the disorder.

2. A mother reports to the nurse at the pediatric clinic that her toddler has had a fever and sore throat for the past two days. The nurse observes several swollen red spots on the child's body, some of which are fluid-filled blisters. What action should the nurse take?

• A. Obtain a fluid culture from the blisters
• B. Administer a fever-reducing medication
• C. Cover the draining vesicles with a dressing
• D. Implement transmission precautions

Correct answer: D

Rationale: The presence of swollen red spots and fluid-filled blisters may indicate a contagious condition. Implementing transmission precautions is crucial to prevent the spread of the infection to others in the clinic setting.

3. A 16-year-old female student with a history of asthma controlled with both an oral antihistamine and an albuterol (Proventil) metered-dose inhaler (MDI) comes to the school nurse. The student complains that she cannot sleep at night, feels shaky, and her heart feels like it is 'beating a mile a minute.' Which information is most important for the nurse to obtain?

• A. When she last took the antihistamine.
• B. When her last asthma attack occurred.
• C. Duration of most asthma attacks.
• D. How often the MDI is used daily.

Correct answer: D

Rationale: The most important information for the nurse to obtain is how often the MDI is used daily. This is crucial to assess if the symptoms of insomnia, shakiness, and rapid heart rate are related to overuse of the inhaler, leading to potential side effects such as systemic effects of beta-2 agonists.

4. Which nursing intervention is most important to include in the plan of care for a child with acute glomerulonephritis?

• A. Encourage fluid intake.
• B. Promote complete bed rest.
• C. Weigh the child daily.
• D. Administer vitamin supplements.

Correct answer: C

Rationale: Weighing the child daily is crucial in managing a child with acute glomerulonephritis as it helps in monitoring fluid retention, which is a key concern in this condition. Daily weight monitoring allows healthcare providers to assess changes in fluid status and adjust treatment accordingly. It is an essential component of the care plan to ensure the child's health status is closely monitored during the management of acute glomerulonephritis. Encouraging fluid intake (Choice A) is generally beneficial but may not be the priority in this case where fluid retention needs close monitoring. Promoting complete bed rest (Choice B) can be important but may not be the most critical intervention. Administering vitamin supplements (Choice D) may not directly address the immediate concerns related to fluid retention in acute glomerulonephritis.

5. The parents of a 15-month-old boy tell the nurse that they are concerned because their son brings his spoon to his mouth but does not turn it over. What action should the nurse implement first?

• A. Discuss the possibility of a referral to a specialist
• B. Question the parents about their concern
• C. Advise the parents on proper spoon handling techniques for the child
• D. Recommend extending mealtimes to allow the child to finish eating

Correct answer: B

Rationale: The initial action for the nurse is to question the parents about their concerns. By doing so, the nurse can gather more information to understand the situation better. This helps in determining if the child's behavior is within normal development or if further action or referrals are necessary. Choice A is incorrect as it jumps to a specialist referral without fully assessing the situation first. Choice C is also incorrect because assuming the parents need advice on proper spoon handling techniques may not be the case. Choice D is incorrect as it does not address the core concern raised by the parents.

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