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 is teaching a parent with a 2-month-old infant who has been diagnosed with colic about ways to relieve colic. Which statement by the parent indicates the need for additional teaching?

• A. I should let my infant cry for at least 30 minutes before I respond.
• B. I will swaddle my infant tightly with a soft blanket.
• C. I should massage my infant's abdomen whenever possible.
• D. I will place my infant in an upright seat after feeding.

Correct answer: A

Rationale: Letting an infant cry for prolonged periods can exacerbate colic and increase the infant's distress. It is better to respond promptly to soothe the baby. Other methods like swaddling, gentle massage, and keeping the infant upright can help relieve colic symptoms.

3. Which muscle is contraindicated for the administration of immunizations in infants and young children?

• A. Deltoid
• B. Dorsogluteal
• C. Ventrogluteal
• D. Anterolateral thigh

Correct answer: B

Rationale: The dorsogluteal muscle is contraindicated for immunizations in infants and young children due to the risk of injury to the sciatic nerve. The anterolateral thigh is the preferred site.

4. The parent of an 8.2-kg (18-lb) 9-month-old infant is borrowing a federally approved car seat from the clinic. The nurse should explain that the safest way to put in the car seat is what?

• A. Front facing in back seat
• B. Rear facing in back seat
• C. Front facing in front seat with air bag on passenger side
• D. Rear facing in front seat if an air bag is on the passenger side

Correct answer: B

Rationale: Infants should be placed rear-facing in the back seat until they are at least 2 years old or exceed the weight/height limit of their car seat for optimal safety.

5. What is the primary concern in a child with nephrotic syndrome?

• A. Hypotension
• B. Hyperkalemia
• C. Hyperlipidemia
• D. Hypocalcemia

Correct answer: C

Rationale: The correct answer is C: Hyperlipidemia. Children with nephrotic syndrome often present with hyperlipidemia due to altered lipid metabolism, making it a primary concern in these patients. Hypotension (choice A) is not a primary concern in nephrotic syndrome. Hyperkalemia (choice B) and hypocalcemia (choice D) are not typically associated with nephrotic syndrome and are less likely to be primary concerns in these patients.

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