Nursing Elites

1. Where in the health history does a record of immunizations belong?

• A. History
• B. Present illness
• C. Review of systems
• D. Physical assessment

Correct answer: A

Rationale: Immunizations are part of the patient’s health history and are recorded under the history section to ensure the child is up-to-date with vaccinations.

2. A thorough systemic physical assessment is necessary in the extremely low-birth-weight (ELBW) infant to detect what?

• A. Weight gain reflective of fluid retention
• B. Difficulties in maternal-child attachment
• C. Subtle changes that may be indicative of an underlying problem
• D. Changes in Apgar score over the first 24 hours of life

Correct answer: C

Rationale: In extremely low-birth-weight (ELBW) infants, a thorough systemic physical assessment is crucial to detect subtle changes that may indicate an underlying problem. These infants are highly vulnerable and may show signs of stress through changes in feeding behavior, activity, color, oxygen saturation, or vital signs. Monitoring weight in ELBW infants primarily reflects genitourinary function rather than fluid retention. Difficulties in maternal-child attachment are important but are usually assessed during parental visits and are not the primary focus of a systemic physical assessment. Changes in the Apgar score are used immediately after birth to assess the transition to extrauterine life and are not as relevant in the following 24 hours to detect ongoing subtle issues.

3. When describing play by the school-aged child to a group of nursing students, the instructor would emphasize the need for which of the following?

• A. Recreation
• B. Ritualism
• C. Physical activity
• D. Rules

Correct answer: D

Rationale: The correct answer is D: Rules. When discussing play in school-aged children, rules are essential as they help in structuring games and social interactions. Rules provide a framework for play, ensuring fairness and cooperation among children. Choice A, recreation, is too broad and doesn't specifically address the importance of rules in play. Choice B, ritualism, is unrelated to the concept of play in school-aged children. Choice C, physical activity, is important for overall health but doesn't capture the specific aspect of rules that are crucial in the play of school-aged children.

4. The nurse is discussing sexually transmitted infections (STIs) with a 17-year-old student. Which cognitive development theory should the teaching plan be based on?

• A. Sensorimotor reactions
• B. Limited cause and effect understanding
• C. Abstract thinking
• D. Concrete thinking

Correct answer: C

Rationale: The correct answer is C: 'Abstract thinking.' According to Piaget’s theory of cognitive development, adolescents, typically around the age of 12 and older, enter the formal operational stage where they can think abstractly and reason about hypothetical situations. When discussing complex topics like STIs with a 17-year-old student, it is essential to base the teaching plan on abstract thinking. Choice A, 'Sensorimotor reactions,' is incorrect as it pertains to the earliest stage in Piaget's theory (birth to 2 years old) focusing on sensory experiences and physical interactions. Choice B, 'Limited cause and effect understanding,' does not align with the cognitive abilities of a 17-year-old who is capable of more advanced thinking. Choice D, 'Concrete thinking,' is also incorrect as it refers to the stage before formal operations, where individuals think more concretely and struggle with abstract concepts.

5. Which pediatric condition is most likely to present with a "whooping" sound during coughing?

• A. Croup
• B. Bronchitis
• C. Pertussis
• D. Asthma

Correct answer: C

Rationale: The correct answer is C: Pertussis. Pertussis, also known as whooping cough, is characterized by a "whooping" sound during coughing episodes. This distinctive sound is due to the rapid intake of air after a series of coughs. Choice A, Croup, typically presents with a barking cough and stridor. Choice B, Bronchitis, is characterized by a productive cough with mucus. Choice D, Asthma, usually presents with wheezing and shortness of breath.

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