Nursing Elites

1. What is an important nursing responsibility when a dysrhythmia is suspected?

• A. order an immediate electrocardiogram
• B. count the radial pulse every 1 minute for five times
• C. count the apical pulse for 1 full minute, and compare the rate with the radial pulse rate
• D. have someone else take the radial pulse simultaneously with the apical pulse

Correct answer: C

Rationale: When a dysrhythmia is suspected, an important nursing responsibility is to count the apical pulse for 1 full minute and then compare this rate with the radial pulse rate. This method helps in identifying dysrhythmias as it allows for a direct comparison of the heart's rhythm at two different pulse points. Ordering an immediate electrocardiogram (Choice A) may be necessary but should not be the first step. Counting the radial pulse multiple times (Choice B) is not as accurate as comparing rates directly. Having someone else take the radial pulse simultaneously (Choice D) may introduce errors and inconsistencies in the measurement.

2. A 6-year-old child with a diagnosis of juvenile idiopathic arthritis (JIA) is being discharged. What should the nurse include in the discharge teaching?

• A. Encourage participation in physical activity
• B. Provide a high-calorie diet
• C. Provide a low-sodium diet
• D. Administer intravenous fluids

Correct answer: A

Rationale: Encouraging regular physical activity is essential in managing symptoms and improving joint function in juvenile idiopathic arthritis. Physical activity helps maintain joint mobility, muscle strength, and overall function. Providing a high-calorie diet may not be necessary unless there are specific concerns about the child's nutritional status. A low-sodium diet is not typically a priority in the management of JIA unless the child has comorbid conditions requiring sodium restriction. Administering intravenous fluids is not a standard discharge teaching for JIA unless there are specific medical indications necessitating it.

3. A child with a diagnosis of acute glomerulonephritis is admitted to the hospital. What is the priority nursing intervention?

• A. Monitoring for hypertension
• B. Providing pain relief
• C. Restricting fluid intake
• D. Encouraging fluid intake

Correct answer: A

Rationale: The correct answer is monitoring for hypertension. Acute glomerulonephritis involves inflammation of the kidney's glomeruli, potentially leading to impaired kidney function and elevated blood pressure. Monitoring for hypertension is crucial as it is a common complication of this condition. Providing pain relief (choice B) may be necessary for comfort but is not the priority. While fluid restriction (choice C) is important in some kidney conditions, in acute glomerulonephritis, maintaining adequate hydration to support kidney function is typically recommended. Encouraging fluid intake (choice D) may exacerbate fluid overload, making it an inappropriate intervention in this scenario.

4. What type of play do nurses expect when observing a toddler in a playroom with other children?

• A. Parallel
• B. Solitary
• C. Cooperative
• D. Competitive

Correct answer: A

Rationale: The correct answer is A: Parallel. Toddlers typically engage in parallel play, where they play alongside but not directly with other children. This type of play is common during early childhood as children are still developing social skills and may prefer to play independently while observing others. Choice B, Solitary play, refers to a child playing alone without interacting with others. Choice C, Cooperative play, involves children playing together towards a common goal or activity. Choice D, Competitive play, emphasizes winning and outperforming others, which is less common in toddlers as they are in the stage of exploring and learning through play rather than competing.

5. When the working mother of a toddler is preparing to take her child home after a prolonged hospitalization, she asks the nurse what type of behavior she should expect to be displayed. What is the nurse’s most appropriate description of her child’s probable behavior?

• A. Excessively demanding behavior
• B. Hostile attitude toward the mother
• C. Cheerful, with shallow attachment behaviors
• D. Withdrawn, without emotional ties to the mother

Correct answer: A

Rationale: After a prolonged hospitalization, a toddler may exhibit excessively demanding behavior as they readjust to being home. This behavior can stem from the child feeling insecure or anxious about the changes in their environment. The child may seek extra attention and reassurance during this transition period. Choices B, C, and D are incorrect because hostility, shallowness in attachment, and withdrawal without emotional ties are less likely behaviors to be displayed by a toddler readjusting to home after a hospital stay.

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