Nursing Elites

1. The parents of a child with sickle cell anemia ask why their child did not have a sickle cell crisis until he was approximately 6 months old. How should the nurse respond?

• A. Your child probably had a crisis, and you were unaware of the symptoms.
• B. Are you sure your child has sickle cell anemia and not sickle cell trait?
• C. Affected children can be asymptomatic in early infancy because of high levels of fetal hemoglobin that inhibit sickling.
• D. Have you asked your doctor about this yet?

Correct answer: C

Rationale: The correct answer is C. Fetal hemoglobin (HbF) is present in high levels during early infancy, inhibiting sickling unlike adult hemoglobin (HbS). As the levels of HbF decrease and HbS increases, the risk of sickling and crises becomes more pronounced, typically after 6 months of age. Choice A is incorrect because it assumes the crisis went unnoticed, which is not supported by medical knowledge. Choice B is incorrect as it questions the child's diagnosis rather than explaining the phenomenon of delayed crises. Choice D is incorrect as it does not provide the parents with the necessary information regarding their query.

2. The nurse observes that a newborn is having problems after birth. What should indicate a tracheoesophageal fistula?

• A. Jitteriness
• B. Meconium ileus
• C. Excessive frothy saliva
• D. Increased need for sleep

Correct answer: C

Rationale: Excessive frothy saliva is a hallmark sign of tracheoesophageal fistula. The abnormal connection between the esophagus and trachea causes difficulty in swallowing, leading to an accumulation of saliva in the mouth. This symptom is crucial for early identification and management of tracheoesophageal fistula. Choices A, B, and D are incorrect as they are not specific indicators of tracheoesophageal fistula.

3. Which electrolyte imbalance is a common concern in children with severe diarrhea?

• A. Hypernatremia
• B. Hypokalemia
• C. Hypercalcemia
• D. Hypomagnesemia

Correct answer: B

Rationale: Hypokalemia is the correct answer because it is a common concern in children with severe diarrhea. Diarrhea can lead to significant potassium loss, resulting in hypokalemia. Hypernatremia (Choice A) is less common in diarrhea as sodium concentration is usually diluted by the fluid loss. Hypercalcemia (Choice C) is not typically associated with severe diarrhea. Hypomagnesemia (Choice D) can occur but is not as common as hypokalemia in this scenario.

4. What is the primary treatment goal for a child with nephrotic syndrome?

• A. Reduce proteinuria
• B. Lower blood pressure
• C. Increase urine output
• D. Prevent infections

Correct answer: A

Rationale: The correct answer is A: Reduce proteinuria. In nephrotic syndrome, the primary treatment goal is to reduce proteinuria to prevent further kidney damage. Lowering blood pressure (choice B) is important in managing some types of kidney disease but is not the primary treatment goal in nephrotic syndrome. Increasing urine output (choice C) and preventing infections (choice D) are important aspects of supportive care but are not the primary treatment goal for nephrotic syndrome.

5. Which statement best describes colic?

• A. Periods of abdominal pain resulting in weight loss
• B. Usually the result of poor or inadequate mothering
• C. Periods of abdominal pain and crying occurring in infants older than age 6 months
• D. A paroxysmal abdominal pain or cramping manifested by episodes of loud crying

Correct answer: D

Rationale: Colic is characterized by episodes of loud, inconsolable crying, often due to abdominal discomfort, and typically occurs in infants younger than 6 months. It is not related to poor mothering, nor does it necessarily result in weight loss.

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