Nursing Elites

1. The parents tell the nurse that their preschooler often awakes from sleep screaming in the middle of the night. The preschooler is not easily comforted and screams if the parents try to restrain the child. What should the nurse instruct the parents to do?

• A. Always read a story to the child before bedtime.
• B. Intervene only if necessary to protect the child from injury.
• C. Discuss counseling options with the primary health care provider.
• D. Try to wake the child and ask the child to describe the dream.

Correct answer: B

Rationale: Waking up screaming from sleep at night indicates sleep terrors. The nurse would advise the parents to observe the child and intervene only if there is a risk for injury. Reading a story before bedtime helps calm the child before sleeping, but it does not ensure that the child will not have a sleep terror. There is no need for professional counseling because sleep terrors are a common phenomenon in preschool-age children. Trying to wake the child and asking the child to describe the dream is not appropriate as the child is not aware of anybody's presence during a sleep terror, and this may cause the child to scream and thrash more.

2. A female client with frequent urinary tract infections (UTIs) asks the nurse to explain her friend's advice about drinking a glass of juice daily to prevent future UTIs. Which response is best for the nurse to provide?

• A. Orange juice has vitamin C that deters bacterial growth.
• B. Apple juice is the most useful in acidifying the urine.
• C. Cranberry juice stops pathogens' adherence to the bladder.
• D. Grapefruit juice increases absorption of most antibiotics.

Correct answer: C

Rationale: The correct answer is 'Cranberry juice stops pathogens' adherence to the bladder.' Cranberry juice maintains urinary tract health by reducing the adherence of Escherichia coli bacteria to cells within the bladder. This helps prevent UTIs. Options A, B, and D are incorrect because orange juice with vitamin C, apple juice for urine acidification, and grapefruit juice for antibiotic absorption do not have the same proven effectiveness in preventing UTIs as cranberry juice does.

3. A 16-month-old child has just been admitted to the hospital. As the nurse assigned to this child enters the hospital room for the first time, the toddler runs to the mother, clings to her, and begins to cry. What would be the initial action by the nurse?

• A. Arrange to change client care assignments.
• B. Explain that this behavior is expected.
• C. Discuss the appropriate use of 'time-out'.
• D. Explain that the child needs extra attention.

Correct answer: B

Rationale: The correct answer is to explain that this behavior is expected. During normal development, fear of strangers becomes prominent beginning around age 6-8 months. Such behaviors include clinging to parents, crying, and turning away from the stranger. These fears and behaviors extend into the toddler period and may persist into preschool. Changing client care assignments (Choice A) is not necessary as the child's behavior is developmentally appropriate. Discussing the appropriate use of 'time-out' (Choice C) is not relevant in this situation as the child is displaying normal attachment behavior, not misbehavior. Explaining that the child needs extra attention (Choice D) may not be necessary as the child is likely seeking comfort from the familiar presence of the mother, which is a typical response in a stressful situation like being in a hospital environment.

4. A parent of a young child says, 'I'm so upset! The doctor prescribed an antidepressant!' Which response is best?

• A. Tell me more about what's bothering you.'
• B. Weren't you told about the need for the medication?'
• C. I'll notify the healthcare provider about your concerns.'
• D. 'Maybe the medication is for attention deficit disorder.'

Correct answer: A

Rationale: The best response in this situation is to express empathy and encourage the parent to share more about their concerns. Option A ('Tell me more about what's bothering you.') allows the nurse to show understanding and gather more information to address the parent's distress effectively. Option B ('Weren't you told about the need for the medication?') is confrontational and may make the parent defensive, hindering effective communication. Option C ('I'll notify the healthcare provider about your concerns.') is premature; the nurse should first assess the parent's feelings before deciding on further actions. Option D ('Maybe the medication is for attention deficit disorder.') assumes without clarification, which is not appropriate; the nurse should validate the prescription before suggesting alternative reasons.

5. Which of the following is an example of neurofeedback used with a child diagnosed with reactive attachment disorder (RAD)?

• A. A child's brain waves are monitored through electrodes placed on the scalp
• B. Parents give their child a sticker when he behaves appropriately
• C. A child uses a sand tray to draw shapes and release stress while talking with a nurse
• D. Parents or a nurse hold a child close during play until he becomes angry enough to unleash his rage

Correct answer: A

Rationale: Neurofeedback is a form of treatment that may be used for children diagnosed with reactive attachment disorder (RAD). Neurofeedback involves attaching electrodes to the scalp in a method similar to an EEG. The child's brainwaves are then monitored while being exposed to positive images or games to produce positive brain patterns. Choice A is the correct answer as it describes the process of neurofeedback, which is a common therapeutic approach for managing RAD. Choices B, C, and D are incorrect because they do not directly involve monitoring brain waves through electrodes to provide feedback for brain pattern adjustments, which is the core concept of neurofeedback therapy.

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