Nursing Elites

1. You are caring for a 6-year-old child with a possible fractured arm and have reason to believe that the child was abused. How should you manage this situation?

• A. Inform the parents of your suspicions.
• B. Transport the child to the hospital regardless of the parents' wishes.
• C. Call the police and have the parents arrested.
• D. Advise the parents that the child needs to be transported.

Correct answer: D

Rationale: In cases where child abuse is suspected, the priority is the safety and well-being of the child. Advising the parents that the child needs to be transported for further evaluation and care is the appropriate initial step. This ensures that the child receives necessary medical attention while also addressing the suspicion of abuse through proper channels. It is essential to involve appropriate authorities and follow established procedures to protect the child and investigate any potential abuse further.

2. When assessing a 5-year-old boy with major trauma, his blood pressure is 70/40 mm Hg, and his pulse rate is 140 beats/min and weak. The child's blood pressure:

• A. indicates decompensated shock.
• B. reflects adequate compensation.
• C. suggests increased intracranial pressure.
• D. is appropriate based on his age.

Correct answer: A

Rationale: In a 5-year-old boy with major trauma, a blood pressure of 70/40 mm Hg and a pulse rate of 140 beats/min, and weak, indicate decompensated shock. This presentation signifies inadequate perfusion, leading to compensatory mechanisms being overwhelmed, resulting in decompensated shock. Choice B is incorrect as the vital signs suggest the body is unable to adequately compensate for the trauma. Choice C is incorrect as the vital signs are more indicative of shock rather than increased intracranial pressure. Choice D is incorrect as such low blood pressure is not appropriate for a child of this age and indicates a critical condition.

3. Use this scenario to answer questions 70 to 72. Madam KK brought her two-month-old sick child to your facility. She complains that the child is having a fever, fast breathing, and is not eating anything. Using the IMNCI, what will be the steps to manage this child?

• A. i. Provide practical treatment instructions
• B. ii. Triage based on the severity of illness
• C. iii. Perform a head-to-toe assessment
• D. iv. Identify specific treatments

Correct answer: D

Rationale: To manage the sick child using IMNCI, the correct steps are as follows: Triage based on the severity of illness, Perform a head-to-toe assessment, Identify specific treatments, Provide practical treatment instructions, and Assess feeding while providing counseling. The correct answer, 'D,' focuses on identifying specific treatments, which is crucial in addressing the child's condition effectively. Choice A ('Provide practical treatment instructions') is not the initial step and should come after identifying specific treatments. Choice B ('Triage based on the severity of illness') and Choice C ('Perform a head-to-toe assessment') are essential steps but should follow the identification of specific treatments in the IMNCI approach.

4. You have arrived for your shift on the children's ward and need to assess a 2-year-old who is accompanied by his father. Identify the appropriate strategy to successfully complete a focused assessment:

• A. Allow the child to inspect the equipment for faults before and during assessment
• B. Ask parent to leave room until assessment has been completed
• C. Perform traumatic or invasive procedures first
• D. Have the child sit in parents lap and request assistance if necessary

Correct answer: D

Rationale: Having the child sit in parent's lap can help reduce anxiety and allow for a more accurate assessment.

5. A postpartum client who delivered a healthy newborn is being assessed by a nurse. Which finding would indicate a complication during the early postpartum period?

• A. Moderate lochia rubra
• B. Bradycardia
• C. Elevated blood pressure
• D. Uterine contraction

Correct answer: C

Rationale: An elevated blood pressure in the postpartum period may indicate the onset of preeclampsia, a serious complication that requires immediate medical attention. Preeclampsia is characterized by high blood pressure, protein in the urine, and sometimes swelling in the hands and face. If left untreated, preeclampsia can lead to serious complications for both the mother and the baby. Therefore, it is crucial for healthcare providers to closely monitor blood pressure levels in postpartum clients to promptly address any signs of preeclampsia. Choices A, B, and D are not indicative of a complication during the early postpartum period. Moderate lochia rubra is a normal finding as it indicates the normal discharge of blood and tissue from the uterus after childbirth. Bradycardia, a slow heart rate, is not typically a concern in the absence of other symptoms or signs of distress. Uterine contractions are essential for involution and are expected in the postpartum period.

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