Nursing Elites

1. A 6-year-old boy with bronchial asthma takes the beta-adrenergic agonist agent albuterol (Proventil). The child's mother tells the nurse that she uses this medication to open her son's airway when he is having trouble breathing. What is the nurse's best response?

• A. Recommend that the mother bring the child in for immediate evaluation
• B. Advise the mother that overuse of the drug may cause chronic bronchitis
• C. Assure the mother that she is using the medication correctly
• D. Confirm that the medication helps to reduce airway inflammation

Correct answer: C

Rationale: The nurse's priority is to reassure the mother that she is using albuterol correctly to open her son's airways during episodes of difficulty breathing. This reassurance helps build trust and ensures that the child receives the intended benefit of the medication. The answer choice recommending immediate evaluation (A) is not appropriate at this point as the mother is using the medication as prescribed. Advising about overuse causing chronic bronchitis (B) is incorrect and may cause unnecessary alarm. Confirming that the medication helps reduce airway inflammation (D) is not the best response because albuterol is a beta-adrenergic agonist used primarily for bronchodilation in acute asthma exacerbations, rather than for reducing inflammation.

2. The practical nurse is reinforcing education with the parents of a child prescribed iron supplements for iron-deficiency anemia. Which statement by the parents indicates they need further instruction?

• A. We will give the iron supplement with milk to reduce stomach upset.
• B. We should give the iron supplement with orange juice to improve absorption.
• C. The supplement may cause the stools to appear dark or black.
• D. We should store the iron supplements out of reach of children.

Correct answer: A

Rationale: Iron supplements should not be given with milk as calcium can interfere with iron absorption. Instead, it is recommended to give it with a source of vitamin C, such as orange juice, to enhance iron absorption. Giving iron supplements with milk may decrease the absorption of iron and should be avoided. Choice B is the correct method to improve iron absorption. Choice C is correct as iron supplements can cause dark or black stools due to unabsorbed iron. Choice D is also correct as iron supplements should always be stored out of reach of children to prevent accidental ingestion.

3. 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.

4. When should a mother introduce solid foods to her 4-month-old baby girl? The mother states, 'My mother says I should put rice cereal in the baby's bottle now.' The nurse should instruct the mother to introduce solid foods when her child exhibits which behavior?

• A. Stops rooting when hungry
• B. Opens mouth when food comes her way
• C. Awakens once for nighttime feedings
• D. Gives up a bottle for a cup

Correct answer: B

Rationale: The correct answer is B: 'Opens mouth when food comes her way.' This behavior indicates readiness to start trying solid foods. Infants should be introduced to solid foods based on developmental cues, such as showing an interest in food and the ability to accept it. Choices A, C, and D are not indicative of readiness for solid foods. Stopping rooting when hungry is a reflex that may persist beyond the readiness for solids. Awakening for nighttime feedings is a normal behavior for a 4-month-old, and transitioning from a bottle to a cup is a later developmental milestone.

5. A mother brings her 3-week-old infant to the clinic because the baby vomits after eating and always seems hungry. Further assessment indicates that the infant’s vomiting is projectile, and the child seems listless. Which additional assessment finding indicates the possibility of a life-threatening complication?

• A. Irregular palpable pulse
• B. Hyperactive bowel sounds
• C. Underweight for age
• D. Crying without tears

Correct answer: D

Rationale: In this scenario, the infant presenting with vomiting, lethargy, and projectile vomiting indicates a potential serious condition. Crying without tears is a sign of dehydration, a critical condition that can lead to life-threatening complications in infants. Dehydration can rapidly worsen an infant's condition, making prompt intervention crucial to prevent further complications. Irregular palpable pulse (Choice A) could indicate a cardiovascular issue but is less immediately life-threatening in this context. Hyperactive bowel sounds (Choice B) are more indicative of gastrointestinal issues rather than a life-threatening complication. Underweight for age (Choice C) may be concerning for growth-related issues but does not directly indicate a life-threatening complication like dehydration does.

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