Nursing Elites

1. Which of the following characteristics apply to 2 to 3-year-old children?

• A. Prefers to feed themselves
• B. Eats very small nutritious meals a day rather than 3 large meals
• C. Can speak in longer sentences
• D. Can use a toothbrush properly

Correct answer: B

Rationale: The correct answer is B. During the age of 2 to 3 years old, children tend to eat very small, nutritious meals throughout the day rather than having three large meals. This behavior is typical for this age group as their appetites fluctuate. Choices A, C, and D are incorrect because while children of this age may start to prefer feeding themselves and begin using a toothbrush with assistance, they typically do not speak in longer sentences at this stage.

2. During the beginning shift assessment of a client with asthma who is receiving oxygen via nasal cannula at 2 liters per minute, the nurse would be most concerned about which unreported finding?

• A. Pulse oximetry reading of 89%
• B. Crackles at the base of the lungs on auscultation
• C. Rapid shallow respirations with intermittent wheezes
• D. Excessive thirst with a dry cracked tongue

Correct answer: C

Rationale: Rapid, shallow respirations with intermittent wheezes are concerning as they indicate a potential worsening of the client's asthma. This finding suggests airway narrowing, which can lead to respiratory failure. Immediate intervention is required to address this respiratory distress. A pulse oximetry reading of 89% is low and indicates hypoxemia, but the respiratory pattern described in option C takes priority as it directly reflects the client's respiratory status. Crackles at the base of the lungs suggest fluid accumulation, which is important but not as immediately critical as the respiratory distress in asthma. Excessive thirst and a dry cracked tongue may indicate dehydration, which is relevant but not as urgent as the respiratory compromise presented in option C.

3. You attended a home delivery with the Rural Health midwife. The newborn is premature. Which of the following should be included in premature infant care at home?

• A. establishing and maintaining good respiration
• B. proper management of feeding
• C. minimum handling of the baby
• D. regulation of body temperature

Correct answer: D

Rationale: Corrected Rationale: Regulation of body temperature is crucial for the survival of a premature infant. Premature infants have difficulty regulating their body temperature, making it essential to keep them warm. While establishing and maintaining good respiration and proper feeding management are important aspects of infant care, they are not as critical as regulating body temperature for premature infants. Additionally, while minimizing handling to reduce stress can be beneficial, it is not as vital as temperature regulation for premature infants.

4. A client with schizophrenia is receiving haloperidol (Haldol). The nurse should monitor the client for which of the following side effects?

• A. Tachycardia
• B. Hypotension
• C. Extrapyramidal symptoms
• D. Hyperglycemia

Correct answer: C

Rationale: The correct answer is C: Extrapyramidal symptoms. Haloperidol is a first-generation antipsychotic that can lead to extrapyramidal symptoms such as tardive dyskinesia and akathisia. These side effects are common with the use of typical antipsychotics. Choice A, Tachycardia, is not a common side effect of haloperidol. Choice B, Hypotension, is also not a typical side effect associated with haloperidol use. Choice D, Hyperglycemia, is not directly linked to haloperidol administration, as it is more commonly associated with other medications like atypical antipsychotics or certain medical conditions.

5. The nurse is assessing a 12-year-old who has Hemophilia A. Which finding would the nurse anticipate?

• A. An excess of red blood cells
• B. An excess of white blood cells
• C. A deficiency of clotting factor VIII
• D. A deficiency of clotting factors VIII and IX

Correct answer: C

Rationale: The correct answer is C: A deficiency of clotting factor VIII. Hemophilia A is characterized by a lack of clotting factor VIII, which is crucial for blood clotting. This deficiency results in prolonged bleeding. Choices A, B, and D are incorrect. There is no association between Hemophilia A and an excess of red blood cells (Choice A) or an excess of white blood cells (Choice B). Additionally, Hemophilia A specifically involves a deficiency of clotting factor VIII, not both factors VIII and IX (Choice D).

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