Nursing Elites

1. Which assessment data would cause suspicion that a 3-year-old child has Hirschsprung disease?

• A. Clay-colored stools and dark urine
• B. History of early passage of meconium in the newborn period
• C. History of chronic, progressive constipation and failure to gain weight
• D. Continual bouts of foul-smelling diarrhea

Correct answer: C

Rationale: Hirschsprung disease is characterized by chronic, progressive constipation and failure to gain weight. These symptoms are indicative of the disorder due to the absence of ganglion cells in the distal colon, leading to impaired motility and obstruction.

2. A healthcare professional is preparing to administer a vaccine to a child who has hemophilia. Which of the following actions should the healthcare professional take?

• A. Administer the vaccine subcutaneously
• B. Administer the vaccine intramuscularly
• C. Use a 1-inch needle
• D. Apply pressure to the site for 1 to 2 minutes

Correct answer: B

Rationale: Administering the vaccine intramuscularly to a child with hemophilia is preferred to reduce the risk of bleeding. Hemophiliac individuals have a decreased ability to form blood clots, and administering vaccines intramuscularly reduces the risk of bleeding compared to subcutaneous administration. Using an appropriate needle length and applying pressure to the site post-injection are important steps, but choosing the intramuscular route is crucial in this case to minimize bleeding complications.

3. In caring for an adolescent with severe abdominal pain due to appendicitis, where should the nurse identify as McBurney's point?

• A. Right lower quadrant
• B. Left lower quadrant
• C. Right upper quadrant
• D. Left upper quadrant

Correct answer: A

Rationale: McBurney's point is located in the right lower quadrant of the abdomen, specifically between the umbilicus and the anterior iliac crest. This point is significant in diagnosing appendicitis, as tenderness at McBurney's point is a classic sign of appendicitis and indicates inflammation near the appendix. Therefore, the correct answer is the 'Right lower quadrant.' Choices B, C, and D are incorrect because McBurney's point is not located in the left lower quadrant, right upper quadrant, or left upper quadrant of the abdomen.

4. A child has a brain tumor. Which of the following findings should the nurse expect?

• A. Decreased head circumference
• B. Frequent headaches
• C. Increased appetite
• D. Increased blood pressure

Correct answer: B

Rationale: Children with brain tumors commonly experience frequent headaches due to increased intracranial pressure. This pressure can result in pain and discomfort, leading to headaches as a common symptom. Other symptoms may include nausea, vomiting, changes in vision, and behavioral changes, but headaches are a prominent feature in children with brain tumors.

5. Which statement most reflects the observation that the infant sleeps soundly, awakens on his own, and maintains a quiet alert state?

• A. This is atypical behavior and should be addressed
• B. The infant should remain on high alert when awake
• C. This shows the infant is making neurological gains
• D. The family is disrupting the child's sleep patterns

Correct answer: C

Rationale: A quiet alert state in infants indicates positive neurological development. It showcases the infant's ability to regulate sleep-wake cycles and maintain an optimal state for learning and interaction. Therefore, observing an infant who sleeps soundly, awakens on his own, and stays in a quiet alert state is a reassuring sign of neurological gains and healthy development. Choice A is incorrect as it misinterprets normal behavior as atypical. Choice B is incorrect as it suggests the infant should be on high alert, which is not developmentally appropriate. Choice D is incorrect as it falsely blames the family for disrupting the child's sleep patterns, whereas the scenario described indicates positive neurological growth.

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