Nursing Elites

1. A 10-year-old child with hemophilia is admitted to the hospital with joint pain and swelling. What should the healthcare provider do first?

• A. Apply ice to the affected joint
• B. Administer pain medication
• C. Elevate the affected limb
• D. Administer factor VIII as prescribed

Correct answer: D

Rationale: Administering factor VIII as prescribed is the priority intervention for a child with hemophilia experiencing joint pain and swelling. Hemophilia is a genetic disorder that impairs the blood's ability to clot properly, leading to prolonged bleeding. Factor VIII replacement therapy is essential as it helps restore the missing clotting factor in patients with hemophilia, thereby aiding in clot formation and preventing further bleeding. Applying ice, administering pain medication, or elevating the limb may be supportive measures but addressing the underlying cause by providing factor VIII therapy takes precedence in managing hemophilia-related joint pain and swelling.

2. The nurse is caring for a 4-year-old child who is hospitalized with pneumonia. The child is receiving IV antibiotics and oxygen therapy. The nurse notes that the child’s respiratory rate is 40 breaths per minute, and the oxygen saturation is 92%. What is the nurse’s priority action?

• A. Increase the child’s oxygen flow rate
• B. Notify the healthcare provider
• C. Encourage the child to take deep breaths
• D. Auscultate the child’s lung sounds

Correct answer: D

Rationale: In this scenario, the child is hospitalized with pneumonia, receiving IV antibiotics and oxygen therapy. With a high respiratory rate and decreased oxygen saturation, auscultating the child’s lung sounds is the priority action. This assessment can provide crucial information about the child’s respiratory status, such as the presence of adventitious sounds or decreased air entry, which can guide further interventions and help in evaluating the effectiveness of the current treatments. Increasing the oxygen flow rate may not address the underlying issue causing the decreased oxygen saturation. Notifying the healthcare provider can be necessary but auscultating lung sounds should be done first to gather more information. Encouraging the child to take deep breaths is important for respiratory function but should not be the immediate priority in this situation.

3. A 3-year-old with HIV infection is staying with a foster family who is caring for 3 other foster children in their home. When one of the children acquires pertussis, the foster mother calls the clinic and asks the nurse what she should do. Which action should the nurse take first?

• A. Remove the child with HIV from the foster home.
• B. Report the exposure of the child with HIV to the health department.
• C. Place the child with HIV in reverse isolation.
• D. Review the immunization documentation of the child with HIV.

Correct answer: D

Rationale: The priority action for the nurse is to review the immunization documentation of the child with HIV. This step ensures that the child has received the necessary vaccines to protect against pertussis and other preventable diseases. It is essential to verify the immunization status to provide appropriate care and prevent further transmission of infectious diseases within the foster home. Removing the child from the foster home (Choice A) may not be necessary if the child is adequately protected through immunization. Reporting the exposure to the health department (Choice B) is important but not the first action. Placing the child in reverse isolation (Choice C) is not indicated for pertussis exposure.

4. Prior to discharge, the parents of a child with cystic fibrosis are demonstrating chest physiotherapy (CPT) that they will perform for their child at home. Which action requires intervention by the nurse?

• A. Plan to perform CPT when the child awakens in the morning.
• B. A cupped hand is used when percussing the lung field.
• C. A bronchodilator is administered before starting CPT.
• D. The child is placed in a supine position to begin percussion.

Correct answer: D

Rationale: The correct answer is D. Placing the child in a supine position to begin percussion is incorrect for chest physiotherapy (CPT). This position is not effective for CPT as it may lead to improper drainage of secretions. The child should be in an appropriate sitting or slightly reclined position to ensure proper lung drainage during CPT. Choices A, B, and C are all appropriate actions for chest physiotherapy. Performing CPT when the child awakens helps in clearing secretions, using a cupped hand during percussion is a proper technique to promote secretion movement, and administering a bronchodilator before CPT can help open up the airways for better clearance.

5. The healthcare provider is providing postoperative care to a 7-year-old child who had surgery for appendicitis. The child is experiencing pain at the surgical site. What is the healthcare provider's priority action?

• A. Administer the prescribed pain medication
• B. Encourage the child to take deep breaths
• C. Apply a warm compress to the surgical site
• D. Reposition the child to a more comfortable position

Correct answer: A

Rationale: Administering the prescribed pain medication is crucial to effectively manage the child's postoperative pain. Pain management is a priority to ensure the child's comfort and promote healing following surgery. Encouraging deep breaths, applying warm compresses, or repositioning the child may help, but addressing the pain with medication is the initial and most vital intervention.

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