Nursing Elites

1. The parents of a newborn with phenylketonuria (PKU) need help and support in adhering to specific dietary restrictions. They ask the nurse, “How long will our child have to be on this diet?” How should the nurse respond?

• A. “We are still not sure; you should discuss this with your health care provider.”
• B. “If your baby does well, foods containing protein can gradually be introduced.”
• C. “Your child needs to be on this diet at least through adolescence and into adulthood.”
• D. “This is a lifelong problem, and it is recommended that dietary restrictions must be continued.”

Correct answer: D

Rationale: The correct answer is D: “This is a lifelong problem, and it is recommended that dietary restrictions must be continued.” Phenylketonuria (PKU) is a metabolic disorder where the body cannot process phenylalanine properly. The diet for PKU must be continued lifelong to prevent cognitive and developmental issues, as phenylalanine buildup can cause irreversible damage. Choice A is incorrect because the nurse should provide information about the lifelong nature of the dietary restrictions for PKU. Choice B is incorrect as it suggests reintroducing protein-containing foods, which is not recommended for individuals with PKU. Choice C is incorrect as it underestimates the duration of the necessary dietary restrictions for PKU.

2. What factor predisposes the urinary tract to infection in children?

• A. increased fluid intake
• B. short urethra in young girls
• C. prostatic secretions in males
• D. frequent emptying of the bladder

Correct answer: B

Rationale: The short urethra in young girls is a significant factor that predisposes them to urinary tract infections. Girls have a shorter urethra than boys, making it easier for bacteria to travel up the urinary tract, leading to infections. Increased fluid intake (Choice A) is actually a preventive measure as it helps flush out bacteria from the urinary tract. Prostatic secretions in males (Choice C) do not predispose the urinary tract to infection in children. Frequent emptying of the bladder (Choice D) is also a good practice to prevent urinary tract infections by reducing the chances of bacterial growth in the urinary tract.

3. A child is being assessed for suspected intussusception. What clinical manifestation is the healthcare provider likely to observe?

• A. Projectile vomiting
• B. Currant jelly stools
• C. Abdominal distension
• D. Constipation

Correct answer: C

Rationale: The correct clinical manifestation the healthcare provider is likely to observe in a child with suspected intussusception is abdominal distension. Intussusception involves one portion of the intestine telescoping into another, causing obstruction. Abdominal distension is a common symptom due to the obstruction and buildup of gas and fluid in the affected area. While projectile vomiting can occur, it is not as specific to intussusception as abdominal distension. Currant jelly stools, which are stools containing blood and mucus, are a classic sign of intussusception but are not a clinical manifestation observable on assessment. Constipation is not typically associated with intussusception, as this condition often presents with symptoms of bowel obstruction rather than constipation.

4. What is an early sign of congestive heart failure that the nurse should recognize?

• A. Tachypnea
• B. Bradycardia
• C. Inability to sweat
• D. Increased urinary output

Correct answer: A

Rationale: Tachypnea, which refers to rapid breathing, is an early sign of congestive heart failure. In heart failure, the heart's inability to pump efficiently can lead to fluid accumulation in the lungs, causing the child to breathe faster to try to compensate for the decreased oxygen exchange. Bradycardia (slow heart rate) is not typically associated with congestive heart failure; instead, it may indicate a different issue. Inability to sweat is not a common early sign of congestive heart failure. Increased urinary output is not a typical early sign of congestive heart failure; instead, it may be a sign of other conditions like diabetes or kidney issues.

5. A child is being assessed by a nurse for suspected nephrotic syndrome. What clinical manifestation is the nurse likely to observe?

• A. Jaundice
• B. Edema
• C. Hypertension
• D. Polyuria

Correct answer: B

Rationale: Edema is a hallmark clinical manifestation of nephrotic syndrome. In nephrotic syndrome, there is increased permeability of the glomerular filtration barrier, leading to protein loss in the urine (proteinuria). The decrease in serum protein levels results in a reduced oncotic pressure, leading to fluid shifting from the intravascular space into the interstitial spaces, causing edema. Jaundice (choice A) is not typically associated with nephrotic syndrome. Hypertension (choice C) is more commonly seen in conditions like nephritic syndrome. Polyuria (choice D) is excessive urination and is not a prominent feature of nephrotic syndrome.

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