Nursing Elites

1. A 2-year-old child with heart failure (HF) is admitted for replacement of a graft for coarctation of the aorta. Prior to administering the next dose of digoxin (Lanoxin), the nurse obtains an apical heart rate of 128 bpm. What action should the nurse take?

• A. Determine the pulse deficit.
• B. Administer the scheduled dose.
• C. Calculate the safe dose range.
• D. Review the serum digoxin level.

Correct answer: B

Rationale: Administering the scheduled dose is appropriate in this scenario since the heart rate of 128 bpm is within an acceptable range for a 2-year-old child with heart failure. Monitoring for signs of digoxin toxicity is important; however, the immediate action required is to administer the scheduled dose as prescribed based on the heart rate assessment.

2. What is the most suitable toy for a 3-year-old boy receiving weekly chemotherapy treatment?

• A. Bouncy ball
• B. Coloring book with crayons
• C. Duck that squeaks
• D. Remote-controlled car

Correct answer: B

Rationale: A coloring book with crayons is the best choice as it is safe, engaging, and can provide a distraction during treatment without posing any safety risks. Coloring activities can help keep the child occupied, promote creativity, and offer a calming and therapeutic outlet during chemotherapy sessions.

3. A child with cystic fibrosis is being discharged home with pancreatic enzyme replacement therapy. What information should the practical nurse reinforce with the parents?

• A. Give the enzymes after meals.
• B. Mix the enzymes with hot food or drinks.
• C. Enzymes should be taken before or with meals.
• D. Avoid giving enzymes with any food or drink.

Correct answer: C

Rationale: The correct answer is C: 'Enzymes should be taken before or with meals.' Pancreatic enzymes should be taken before or with meals to assist with digestion in children with cystic fibrosis. This timing helps maximize the effectiveness of the enzymes in breaking down nutrients from food. Giving the enzymes after meals (choice A) may not provide the necessary support for digestion. Mixing the enzymes with hot food or drinks (choice B) is not recommended as it may affect the enzymes' efficacy. Avoiding giving enzymes with any food or drink (choice D) is incorrect as enzymes need to be taken in conjunction with meals to aid in digestion.

4. A child with leukemia is admitted for chemotherapy, and the nursing diagnosis 'altered nutrition, less than body requirements related to anorexia, nausea, and vomiting' is identified. Which intervention should the nurse include in this child's plan of care?

• A. Encourage a variety of large portions of food at every meal.
• B. Allow the child to eat any food desired and tolerated.
• C. Recommend eating the food as siblings eat at home.
• D. Restrict food brought from fast-food restaurants.

Correct answer: B

Rationale: Allowing the child to eat any food desired and tolerated is the most appropriate intervention in this scenario. Anorexia, nausea, and vomiting are common side effects of chemotherapy, which can lead to altered nutrition. Allowing the child to choose foods they desire and can tolerate can help improve their nutritional intake during this challenging time. Encouraging large portions of food at every meal (Choice A) may overwhelm the child and worsen their symptoms. Eating like siblings at home (Choice C) may not align with the child's specific needs during chemotherapy. Restricting food from fast-food restaurants (Choice D) is not necessary as long as the food choices are suitable for the child's condition and preferences.

5. While auscultating the lung sounds of a 5-year-old Chinese boy who recently completed antibiotic therapy for pneumonia, the nurse notices symmetrical, round, bruise-like blemishes on his chest. What action is best for the nurse to take?

• A. Identify the antibiotics used for treating the pneumonia.
• B. Inquire about the use of alternative treatment methods.
• C. Ask the parents if the child has been in a recent accident.
• D. Report suspected child abuse to the authorities.

Correct answer: B

Rationale: Inquiring about the use of alternative treatment methods is essential to understand cultural practices and provide holistic care. It allows the nurse to gather more information about the blemishes and potentially uncover traditional or alternative healing approaches that the family may have used. This approach demonstrates cultural sensitivity and a comprehensive assessment before making assumptions or taking further actions. Identifying the antibiotics used for treating pneumonia (Choice A) is not immediately necessary in this context as the focus is on the blemishes. Asking about a recent accident (Choice C) assumes a traumatic cause without evidence. Reporting suspected child abuse (Choice D) is premature without further assessment or evidence of abuse.

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