Nursing Elites

1. When instilling ear drops in a 2-year-old child, how should the practical nurse (PN) position the earlobe to straighten the external auditory canal?

• A. Up and back.
• B. Down and back.
• C. Up and forward.
• D. Down and forward.

Correct answer: B

Rationale: When administering ear drops to a child under three years old, it is essential to pull the earlobe down and back. This positioning helps straighten the external auditory canal, facilitating the proper administration of the ear drops. Pulling the earlobe down and back in young children aims to ensure that the medication reaches the intended area for optimal effectiveness.

2. What information should the practical nurse ensure the family understands about caring for a child with a tracheostomy?

• A. Cardiopulmonary resuscitation.
• B. Hygiene practices, including showering.
• C. Proper technique for tracheostomy suctioning.
• D. Application of powder around the stoma.

Correct answer: A

Rationale: The correct answer is A: Cardiopulmonary resuscitation. It is essential for families to be educated in cardiopulmonary resuscitation (CPR) to manage emergencies involving patients with tracheostomies. Maintaining a clear airway is crucial for the child's safety and well-being. Choice B, hygiene practices, although important, is not as critical as CPR in managing a tracheostomy. Choice C, the proper technique for tracheostomy suctioning, is also crucial but does not take precedence over CPR in emergency situations. Choice D, application of powder around the stoma, is not a standard practice and may not be necessary for tracheostomy care.

3. A toddler with a chronic illness that requires frequent hospitalization is likely to experience which psychosocial developmental challenge?

• A. Fixation with feelings of inadequacy
• B. Interference with the development of autonomy
• C. Distortion of differentiation of self from parent
• D. Delayed language, fine-motor, and self-care skills

Correct answer: B

Rationale: Toddlers with chronic illnesses requiring frequent hospitalization may experience interference with the development of autonomy. This is because the need for constant medical care can restrict their independence and ability to explore and make choices, which are essential aspects of achieving autonomy according to Erikson's stages of psychosocial development. Choices A, C, and D are incorrect. Fixation with feelings of inadequacy (Choice A) is more commonly associated with Erikson's stage of industry vs. inferiority in middle childhood. Distortion of differentiation of self from parent (Choice C) is related to the separation-individuation phase of Mahler's theory of object relations, typically occurring in infancy. Delayed language, fine-motor, and self-care skills (Choice D) may be impacted by chronic illness but are not the primary psychosocial developmental challenge faced by toddlers in this context.

4. A 4-year-old child is brought to the clinic with complaints of ear pain and fever. The practical nurse suspects otitis media. Which symptom supports this suspicion?

• A. Clear nasal discharge.
• B. Dry, hacking cough.
• C. Tugging at the ear.
• D. Sore throat.

Correct answer: C

Rationale: Tugging at the ear is a common symptom in children with otitis media. It often indicates discomfort or pain in the ear, suggesting inflammation or infection in the middle ear. This behavior is frequently observed in young children who are unable to express their discomfort verbally, making it a significant clinical indicator for otitis media in this age group. Clear nasal discharge (Choice A) is more indicative of a cold or allergies, while a dry, hacking cough (Choice B) is not typically associated with otitis media. Although a sore throat (Choice D) can sometimes accompany ear infections, tugging at the ear is a more specific and reliable symptom in this case.

5. What is the best response for the nurse when a 2-year-old boy begins to cry as the mother starts to leave?

• A. Let me read this book to you.
• B. Two-year-olds usually stop crying the minute the parent leaves.
• C. Now be a big boy. Mommy will be back soon.
• D. Let's wave bye-bye to mommy.

Correct answer: D

Rationale: The best response for the nurse in this situation is to help the child understand that the separation is temporary. Waving bye-bye to mommy can be reassuring to the child and make the separation process easier. It acknowledges the child's feelings while providing a positive and comforting interaction. Choice A may distract the child temporarily but doesn't address the underlying issue of separation anxiety. Choice B is inaccurate as children may continue to cry even after the parent leaves. Choice C diminishes the child's emotions and doesn't offer a supportive approach.

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