Nursing Elites

1. Why is the infant scheduled to receive the intramuscular polio vaccine instead of the oral vaccine, as asked by the parents?

• A. The American Academy of Pediatrics recommends the intramuscular vaccine because it is safer.
• B. Both vaccines produce the same results and are equally safe, according to consensus.
• C. The intramuscular vaccine is preferred over the oral vaccine due to cost considerations, unless contraindicated.
• D. The U.S. Centers for Disease Control and Prevention recommends the intramuscular vaccine unless the infant or a family member is immunocompromised.

Correct answer: A

Rationale: The American Academy of Pediatrics recommends the intramuscular polio vaccine over the oral vaccine due to its superior safety profile. Intramuscular administration ensures better immunogenicity and protection against poliovirus. Choice B is incorrect as the intramuscular vaccine is preferred for safety reasons. Choice C is incorrect because the recommendation is based on safety, not cost. Choice D is incorrect as the CDC recommendation is not solely based on immunocompromised status but rather on the overall safety and efficacy of the vaccine.

2. A healthcare professional is assessing a child with suspected pertussis. What clinical manifestation is the healthcare professional likely to observe?

• A. Dry, hacking cough
• B. Inspiratory stridor
• C. Nasal congestion
• D. Severe coughing spells

Correct answer: D

Rationale: Severe coughing spells are a hallmark clinical manifestation of pertussis. Pertussis, also known as whooping cough, is characterized by paroxysms of rapid, consecutive coughs followed by a distinctive 'whoop' sound as the patient gasps for air. This intense coughing can lead to vomiting, exhaustion, and sometimes a characteristic 'whoop' sound. Inspiratory stridor (Choice B) is more commonly associated with croup, not pertussis. Nasal congestion (Choice C) is not a typical feature of pertussis. While a cough is present in pertussis, the specific type of cough described in Choice A (dry, hacking cough) is not the predominant feature observed in pertussis.

3. A child with suspected Kawasaki disease is being assessed. What clinical manifestation is the nurse likely to observe?

• A. Generalized rash
• B. Peeling skin on the hands and feet
• C. High fever
• D. Low-grade fever

Correct answer: B

Rationale: Peeling skin on the hands and feet is a characteristic clinical manifestation of Kawasaki disease, known as desquamation. This occurs during the convalescent phase of the illness, typically around 2-3 weeks after the onset of symptoms. While a generalized rash can be present in Kawasaki disease, peeling skin on the hands and feet is a more specific and distinctive feature. High fever is also a common symptom of Kawasaki disease, usually lasting for at least 5 days, while a low-grade fever is not typically associated with this condition. Therefore, the nurse is more likely to observe peeling skin on the hands and feet in a child suspected of having Kawasaki disease, making option B the correct choice.

4. A 2-week-old infant is admitted with a tentative diagnosis of a ventricular septal defect. The parents report that their baby has had difficulty feeding since coming home after birth. What should the nurse consider before responding?

• A. Feeding problems are common in neonates.
• B. Inadequate sucking is not significant in the absence of cyanosis.
• C. Ineffective sucking and swallowing may be early indications of a heart defect.
• D. Many neonates retain mucus, which may interfere with feeding for several weeks.

Correct answer: C

Rationale: In this scenario, the nurse should consider that ineffective sucking and swallowing in a 2-week-old infant could be early signs of a heart defect such as a ventricular septal defect. This is crucial information as it can guide further assessment and management. Choice A is incorrect because while feeding problems can be common in neonates, in this case, the specific context of a suspected heart defect should be prioritized. Choice B is incorrect as inadequate sucking can indeed be significant, especially when considering potential underlying heart issues, regardless of the presence of cyanosis. Choice D is incorrect as while mucus retention can affect feeding, in this case, the focus should be on the possibility of a heart defect rather than a temporary issue like mucus interference.

5. A 4-year-old child is scheduled for a myringotomy. What should the nurse include in the preoperative teaching?

• A. Explain the procedure in simple terms
• B. Encourage fluid intake
• C. Allow the child to play with medical equipment
• D. Use play therapy to prepare the child

Correct answer: A

Rationale: Explaining the procedure in simple terms is essential preoperative teaching for a 4-year-old child scheduled for a myringotomy. This approach helps the child understand what will happen during the procedure, reducing anxiety and fear. Encouraging fluid intake is a good general health practice but not directly related to preoperative teaching for this procedure. Allowing the child to play with medical equipment may not be safe or appropriate as it can lead to misunderstanding or fear. Using play therapy can be beneficial but explaining the procedure in simple terms is more direct and effective for preoperative teaching in this case.

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