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. During a well-child visit, a 10-year-old child is found to be above the 95th percentile for weight and reports watching more than two hours of television daily. An appropriate nursing diagnosis for this child is:

• A. Imbalanced Nutrition: More than body requirements
• B. Altered Growth and Development
• C. Ineffective Coping
• D. Altered Family Processes

Correct answer: A

Rationale: The correct nursing diagnosis for a 10-year-old child who is above the 95th percentile for weight and watches more than two hours of television daily would be 'Imbalanced Nutrition: More than body requirements.' This diagnosis reflects the excessive intake of nutrients compared to the child's energy expenditure, which can contribute to weight gain. 'Altered Growth and Development' (choice B) is not the most appropriate diagnosis in this scenario, as the primary concern is related to nutrition and sedentary behavior rather than developmental issues. 'Ineffective Coping' (choice C) and 'Altered Family Processes' (choice D) are also not relevant to the child's weight status and television habits. Monitoring and addressing the child's dietary habits and sedentary behavior are essential to promote a healthier lifestyle and prevent further weight-related issues.

3. Which of the following is not an infectious cause of diarrhea?

• A. Allergy
• B. Bacteria
• C. Parasite
• D. Virus

Correct answer: A

Rationale: The correct answer is A: Allergy. Allergy is not an infectious cause of diarrhea. Diarrhea caused by bacteria, parasites, and viruses is due to infection, while an allergy triggers an immune response that can lead to diarrhea but is not caused by an infectious agent. Choices B, C, and D are incorrect because bacteria, parasites, and viruses are known infectious causes of diarrhea, resulting from infections by these microorganisms.

4. Mrs. Byers tells the nurse that she is very worried because her 2-year-old child does not finish his meals. What should the nurse advise the mother?

• A. Make the child seat with the family in the dining room until he finishes his meal
• B. Provide quiet environment for the child before meals
• C. Do not give snacks to the child before meals
• D. Put the child on a chair and feed him

Correct answer: C

Rationale: Providing a quiet environment can help the child focus on eating.

5. A mother of a 6-year-old actively playing child, diagnosed with type 1 diabetes mellitus a year ago, calls a clinic nurse and reports that the child has been sick. She checked the child's urine, which was positive for ketones. What should the nurse instruct the mother to do?

• A. Administer an additional dose of regular insulin
• B. Come to the clinic immediately
• C. Encourage the child to drink liquids
• D. Hold the next dose of insulin

Correct answer: C

Rationale: Encouraging the child to drink liquids is essential in managing ketones in urine. Increased fluid intake can help prevent dehydration and aid in flushing out ketones, which is crucial in managing diabetic ketoacidosis, a serious complication of uncontrolled diabetes.

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