Nursing Elites

1. Which factor is most likely to cause a "brittle" diabetic state in a child with type 1 diabetes?

• A. Noncompliance with diet
• B. Insulin resistance
• C. Frequent infections
• D. Hypothyroidism

Correct answer: C

Rationale: Frequent infections can destabilize blood sugar levels, leading to a "brittle" diabetic state in children with type 1 diabetes. Infections increase metabolic demands and can result in significant blood glucose fluctuations, requiring careful monitoring and adjustment of insulin therapy. Noncompliance with diet may affect blood sugar control but is not the primary cause of a "brittle" state. Insulin resistance is more common in type 2 diabetes rather than type 1. Hypothyroidism can impact metabolism but is not directly linked to the development of a "brittle" diabetic state in type 1 diabetes.

2. The clinic nurse is reviewing the immunization guidelines for hepatitis B. Which are true of the guidelines for this vaccine?

• A. The hepatitis B vaccination series should be begun at birth
• B. All are applicable
• C. Any child not vaccinated at birth should receive two doses at least 4 months apart
• D. An unimmunized 10-year-old child should receive three doses administered 4 weeks apart

Correct answer: B

Rationale: Hepatitis B vaccination should start at birth, and any child or adolescent not vaccinated should complete the series. Adolescents should receive three doses if they were not previously vaccinated.

3. What dietary modification is recommended for a child with cystic fibrosis?

• A. High carbohydrate
• B. Low protein
• C. High calorie
• D. Low fat

Correct answer: C

Rationale: A high-calorie diet is recommended for children with cystic fibrosis due to their increased energy needs and malabsorption issues. Cystic fibrosis affects the pancreas, leading to poor digestion and absorption of nutrients, particularly fats, which requires dietary adjustments to maintain adequate nutrition. High carbohydrate (Choice A) is not the primary focus; the emphasis is on overall calorie intake. Low protein (Choice B) is not recommended as protein intake is essential for growth and development. Low fat (Choice D) is not the best option as fat-soluble vitamin absorption is already compromised in cystic fibrosis, hence fat restriction is not a priority.

4. What is a key distinguishing feature of bronchiolitis in infants?

• A. Dry cough
• B. Wheezing
• C. Stridor
• D. Productive cough

Correct answer: B

Rationale: The correct answer is B: Wheezing. Wheezing is a key distinguishing feature of bronchiolitis in infants, typically caused by respiratory syncytial virus (RSV) infection. Bronchiolitis is characterized by inflammation and mucus buildup in the small airways of the lungs, leading to wheezing sounds during breathing. Choices A, C, and D are incorrect because dry cough, stridor, and productive cough are not typical features of bronchiolitis in infants.

5. Which vaccine is contraindicated in a child with a history of severe egg allergy?

• A. MMR
• B. Varicella
• C. Influenza
• D. Hepatitis B

Correct answer: C

Rationale: The correct answer is C: Influenza. The influenza vaccine is produced using egg-based technology, so individuals with a severe egg allergy are at risk of an allergic reaction if vaccinated with the influenza vaccine. This is due to the potential presence of egg proteins in the vaccine. Choices A, B, and D are not contraindicated in children with severe egg allergy. The MMR and Varicella vaccines do not pose a risk for children with egg allergies, and the Hepatitis B vaccine is also safe for these individuals.

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