Nursing Elites

1. A 4-year-old boy with a tracheostomy tube is experiencing respiratory distress. He has intercostal retractions, a heart rate of 80 beats/min, and an oxygen saturation of 85%. During his attempts to breathe, a gurgling sound is heard in the tracheostomy tube. You should:

• A. Ventilate through the tracheostomy tube.
• B. Place an oxygen mask over the tracheostomy tube.
• C. Remove the tracheostomy tube and clean it.
• D. Carefully suction the tracheostomy tube.

Correct answer: D

Rationale: In this scenario, the 4-year-old boy with a tracheostomy tube is showing signs of respiratory distress, including intercostal retractions, a low heart rate, and decreased oxygen saturation. The gurgling sound indicates a possible airway obstruction. Correctly, the immediate action should be to carefully suction the tracheostomy tube. Suctioning can help clear any secretions or obstructions, thus improving the child's ability to breathe effectively. Ventilating through the tube, placing an oxygen mask over it, or removing and cleaning the tube would not address the potential obstruction and could worsen the respiratory distress.

2. How would you classify a child at two years of age who has fast breathing without chest indrawing or stridor when calm?

• A. Very severe disease
• B. Pneumonia
• C. No pneumonia
• D. Local infection

Correct answer: B

Rationale: In pediatric clinical assessment, a child at two years of age with fast breathing but without chest indrawing or stridor when calm is classified as having pneumonia. Fast breathing in this context is a key symptom used in the Integrated Management of Childhood Illness (IMCI) guidelines to diagnose pneumonia in children under five years old. The absence of chest indrawing or stridor when the child is calm helps differentiate this case from other respiratory conditions, making pneumonia the likely classification. Choices A, C, and D are incorrect. 'Very severe disease' is too broad and not specific to the symptoms described. 'No pneumonia' is also incorrect as the symptoms match the presentation of pneumonia. 'Local infection' is too vague and does not specifically address the respiratory symptoms observed.

3. Madam Serwaa's 7-month-old baby was admitted to your ward with malnutrition. The child has diarrhea with signs of moderate dehydration but can drink. Which of the following will be the most appropriate fluid for Madam Serwaa's baby?

• A. ORS
• B. Resomal
• C. Rice water
• D. I.V. Ringer's lactate

Correct answer: A

Rationale: For a 7-month-old baby with diarrhea and signs of moderate dehydration who can still drink, the most appropriate fluid is Oral Rehydration Solution (ORS). ORS helps in rehydrating the body and replenishing lost electrolytes, making it essential in managing dehydration due to diarrhea.

4. Which intervention is not appropriate for the hospitalized adolescent?

• A. Allowing the adolescent to assist with procedures when possible.
• B. Encouraging them to discuss their thoughts and feelings about the hospitalization.
• C. Encouraging them to remain in the room throughout the hospitalization to ensure adequate rest periods.
• D. Encouraging peer visitation.

Correct answer: C

Rationale: Encouraging the adolescent to remain in the room throughout the hospitalization to ensure adequate rest periods is not appropriate. It is crucial for adolescents to have opportunities for physical activity and social interaction to promote their well-being during hospitalization. Allowing them to assist with procedures when possible can empower them and provide a sense of control. Encouraging discussions about their thoughts and feelings helps address their emotional needs. Facilitating peer visitation fosters social support, which is beneficial for their well-being. Therefore, choice C is the least appropriate as it restricts important aspects of the adolescent's development and coping mechanisms during hospitalization.

5. Which of the following are classical clinical manifestations that a patient with diabetes mellitus will exhibit EXCEPT?

• A. Polyuria
• B. Polydipsia
• C. Diabetic Ketoacidosis
• D. Weight loss

Correct answer: C

Rationale: The classical clinical manifestations of diabetes mellitus include polyuria (increased urination), polydipsia (excessive thirst), and weight loss. Diabetic ketoacidosis is not a classical manifestation but rather a serious complication that can occur in individuals with uncontrolled diabetes.

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