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. The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. What should the nurse explain about exercise in type 1 diabetes?

• A. Exercise will increase blood glucose levels
• B. Exercise should be restricted
• C. Extra snacks are needed before exercise
• D. Extra insulin is required during exercise

Correct answer: C

Rationale: In type 1 diabetes, extra snacks are needed before exercise to prevent hypoglycemia. It is important to provide additional carbohydrates to maintain blood glucose levels during physical activity. Choices A, B, and D are incorrect. Exercise typically lowers blood glucose levels in individuals with diabetes; however, proper management and adjustments in insulin and food intake are necessary to prevent hypoglycemia. Exercise should not be restricted in individuals with type 1 diabetes but should be planned in coordination with healthcare providers to ensure safety and optimal glucose control. While some individuals may need adjustments in insulin dosages during exercise, the general statement that extra insulin is required during exercise in type 1 diabetes is not accurate.

3. Surgical repair for patent ductus arteriosus (PDA) is done to prevent the complication of

• A. pulmonary infection
• B. right-to-left shunt of blood
• C. decreased workload on the left side of the heart
• D. increased pulmonary vascular congestion

Correct answer: D

Rationale: Surgical repair of patent ductus arteriosus (PDA) aims to prevent increased pulmonary vascular congestion, which can lead to congestive heart failure and respiratory distress. Choice A, pulmonary infection, is not a direct complication of PDA but rather a result of other factors. Choice B, right-to-left shunt of blood, is a characteristic of a different heart condition (e.g., Tetralogy of Fallot) and not specifically associated with PDA. Choice C, decreased workload on the left side of the heart, is not a typical complication of PDA but rather a consequence of left-to-right shunting that can cause volume overload in the pulmonary circulation.

4. An infant who has had diarrhea for 3 days is admitted in a lethargic state and is breathing rapidly. The parent states that the baby has been ingesting formula, although not as much as usual, and cannot understand the sudden change. What explanation should the nurse give the parent?

• A. Cellular metabolism is unstable in young children.
• B. The proportion of water in the body is less than in adults.
• C. Renal function is immature in children until they reach school age.
• D. The extracellular fluid requirement per unit of body weight is greater than in adults.

Correct answer: D

Rationale: The correct answer is D. Infants have a higher extracellular fluid requirement per unit of body weight, making them more susceptible to dehydration and electrolyte imbalances during illnesses such as diarrhea. Choice A is incorrect because cellular metabolism being unstable is not the primary explanation for the symptoms described. Choice B is incorrect as the proportion of water in the body alone does not fully explain the increased risk of dehydration in infants. Choice C is incorrect because while renal function is immature in children, it is not the most relevant factor in this scenario compared to the increased fluid requirements.

5. What should be the priority action when caring for a child with acute laryngotracheobronchitis?

• A. Initiate measures to reduce fever.
• B. Ensure delivery of humidified oxygen.
• C. Provide support to reduce apprehension.
• D. Continually assess the respiratory status.

Correct answer: D

Rationale: When caring for a child with acute laryngotracheobronchitis, the priority action should be to continually assess the respiratory status. This is crucial to detect early signs of respiratory distress, such as worsening stridor or increased work of breathing. Prompt intervention can prevent further deterioration of the child's condition. Initiating measures to reduce fever (Choice A) may be necessary but is not the priority in this situation. Ensuring delivery of humidified oxygen (Choice B) is important for maintaining oxygenation but should follow the assessment of respiratory status. Providing support to reduce apprehension (Choice C) is also important for the child's comfort but is not the priority over assessing and managing respiratory distress.

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