Nursing Elites

1. A 5-year-old has patient-controlled analgesia (PCA) for pain management after abdominal surgery. What information does the nurse include in teaching the parents about the PCA?

• A. The child may not be pain-free.
• B. The parents or nurse may push the button for a bolus if needed.
• C. The pump allows for a continuous basal rate to deliver a constant amount of medication for pain control.
• D. Monitoring is required every 1 to 2 hours to assess patient response.

Correct answer: C

Rationale: The correct answer is C because the PCA pump can be programmed to deliver a continuous basal rate of pain medication to maintain pain control. While the goal of PCA is effective pain relief, it does not guarantee a pain-free state. In the case of a 5-year-old child, the parents or nurse can administer boluses if necessary since the child may not fully comprehend using the PCA button. Monitoring every 1 to 2 hours for patient response is adequate and there is no need for monitoring every 15 minutes, as stated in choice D, unless specific circumstances dictate more frequent monitoring.

2. Superficial palpation of the abdomen is often perceived by the child as tickling. Which measure by the nurse is most likely to minimize this sensation and promote relaxation?

• A. Palpate another area simultaneously
• B. Ask the child not to laugh or move
• C. Begin with deeper palpation and gradually progress to superficial palpation
• D. Have the child help with palpation by placing his or her hand over the palpating hand

Correct answer: D

Rationale: Allowing the child to place their hand over the nurse's hand helps reduce the tickling sensation and increases the child's comfort during the examination.

3. The nurse is caring for a child with Neuroblastoma. Where is the tumor most commonly located?

• A. Bone
• B. Kidneys
• C. Cortex
• D. Abdomen

Correct answer: D

Rationale: Neuroblastoma is a cancer that commonly originates in the adrenal glands located in the abdomen. It can also occur in nerve tissues along the spine, but it is most frequently found in the abdominal region. Therefore, the correct answer is D. Choices A, B, and C are incorrect as Neuroblastoma typically arises from neural crest cells in the adrenal glands or sympathetic ganglia, not in the bones, kidneys, or cortex.

4. Which food should be introduced first to a 6-month-old infant?

• A. Fruits
• B. Eggs
• C. Vegetables
• D. Meat

Correct answer: C

Rationale: Vegetables, particularly pureed ones, are often recommended as a first solid food for infants because they are easy to digest and less likely to cause allergies. Fruits can be introduced later due to their natural sweetness, while eggs and meat are typically introduced after fruits and vegetables as they may pose a higher risk of allergies.

5. What is a priority intervention for an infant with a temporary colostomy for Hirschsprung disease?

• A. Teaching how to irrigate the colostomy
• B. Protecting the skin around the colostomy
• C. Discussing the implications of a colostomy during puberty
• D. Using simple, straightforward language to prepare the child

Correct answer: B

Rationale: Protecting the skin around the colostomy is crucial to prevent irritation and infection, which are common complications in infants with colostomies. Teaching and discussing long-term implications are important but secondary to immediate skin care needs.

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