Nursing Elites

1. What time frame has the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists recommended that pregnant adolescents and women who are not protected against pertussis receive the tetanus, diphtheria, and pertussis (Tdap) vaccine?

• A. Between 27 and 36 weeks of gestation or postpartum before discharge from the hospital
• B. During the first prenatal visit when pregnancy is confirmed
• C. The vaccine should be administered 24 hours prior to delivery
• D. This vaccine is only recommended during the first trimester

Correct answer: A

Rationale: The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists recommend that pregnant adolescents and women without protection against pertussis should receive the Tdap vaccine ideally between 27 and 36 weeks of gestation or postpartum before discharge from the hospital. This timeframe allows for the development of antibodies in the mother to protect her and provide passive immunity to the infant. Administering the vaccine during the first trimester (Choice D) is not recommended as the optimal time is between 27 and 36 weeks. Choice B, during the first prenatal visit, is too early for optimal protection, and Choice C, 24 hours prior to delivery, does not provide enough time for the vaccine to be effective before birth.

2. A child is admitted to the hospital with acute renal failure. The parents ask about the prognosis for acute renal failure. The nurse’s response should be based on which statement about acute renal failure?

• A. Children with acute renal failure will have to take prophylactic antibiotics for life.
• B. Acute renal failure always leads to chronic renal failure.
• C. Acute renal failure may be reversible.
• D. All children with acute renal failure will eventually need a kidney transplant.

Correct answer: C

Rationale: The correct answer is C: Acute renal failure in children is often reversible, especially when the underlying cause is identified and treated promptly. It does not always lead to chronic renal failure or the need for a kidney transplant. Choice A is incorrect as prophylactic antibiotics for life are not a standard treatment for acute renal failure. Choice B is incorrect as acute renal failure does not always progress to chronic renal failure. Choice D is incorrect as not all children with acute renal failure will eventually require a kidney transplant.

3. An adolescent states, “I want to be a doctor or a lawyer when I grow up because I like taking care of people.” Which Eriksonian challenge is the adolescent attempting?

• A. Identity vs. role diffusion
• B. Trust vs. mistrust
• C. Industry vs. inferiority
• D. Autonomy vs. shame and doubt

Correct answer: A

Rationale: The correct answer is A: Identity vs. role diffusion. During adolescence, individuals face the challenge of forming a cohesive sense of self and identity. In this scenario, the adolescent's desire to become a doctor or lawyer reflects the exploration of potential roles and career paths, indicating an attempt to establish a clear identity. Choices B, C, and D are incorrect. Trust vs. mistrust is a challenge experienced in infancy, industry vs. inferiority is relevant to the school-age period, and autonomy vs. shame and doubt is associated with the toddler stage, not adolescence.

4. During a well-child checkup, the parent of a 5-year-old child reports the child seems much smaller than the 2 older siblings did at this same age. A review of the medical record reveals that the child is 44 inches tall and weighs 42 pounds. What information should be included in the response by the nurse?

• A. The weight of your child at this time is within normal limits for this age but the child is moderately taller than other children this age.
• B. Your child is within the acceptable range for height but the child is significantly smaller in weight for this age.
• C. Your child is within normal limits for weight but the child is slightly shorter in stature than other children this age.
• D. Your child is slightly taller than other children this age but the child’s weight is normal.

Correct answer: D

Rationale: The correct answer is D. The child is slightly taller than average, but the weight is within normal limits. This information should be reassuring to the parent and provides insights into normal growth patterns. Choice A is incorrect as it inaccurately states that the child is taller than other children this age. Choice B is incorrect because the child's weight is actually within normal limits. Choice C is incorrect as it inaccurately states that the child is shorter in stature than other children this age.

5. You are providing a home health care assessment for a very low-income mother with three young children under 5 who all appear to be at nutritional risk. Which program would you refer them to in an attempt to reduce the risk and safeguard the health of this family?

• A. Division of Maternal and Child Health
• B. Medicaid
• C. Supplemental Food Program for Women, Infants, and Children
• D. The State Children’s Health Insurance Program

Correct answer: C

Rationale: The correct answer is C, the Supplemental Food Program for Women, Infants, and Children (WIC). WIC provides nutritional assistance to low-income pregnant women, breastfeeding women, and children under 5. The Division of Maternal and Child Health (Choice A) focuses on promoting the health of mothers and children but does not provide direct nutritional assistance. Medicaid (Choice B) is a health insurance program for low-income individuals but does not specifically address nutritional needs. The State Children’s Health Insurance Program (Choice D) provides health insurance for children in low-income families but does not offer nutritional support like WIC does.

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