Nursing Elites

1. A 6-year-old child with sickle cell anemia presents to the emergency department with severe pain in the legs and abdomen. The child is crying and states that the pain is unbearable. What is the nurse’s priority action?

• A. Apply warm compresses to the painful areas
• B. Administer prescribed pain medication
• C. Encourage the child to drink fluids
• D. Monitor the child’s oxygen saturation

Correct answer: B

Rationale: In a sickle cell crisis, pain management is a priority to alleviate the child's suffering. Administering the prescribed pain medication is crucial to address the severe pain experienced by the child. Warm compresses, encouraging fluid intake, and monitoring oxygen saturation are important interventions but should follow the priority of pain management in this situation.

2. A 5-year-old child is brought to the emergency department with severe abdominal pain and vomiting. The child’s parent reports that the pain started suddenly and is located in the lower right abdomen. What should the nurse do first?

• A. Administer pain medication
• B. Notify the healthcare provider immediately
• C. Start an IV line for fluid administration
• D. Obtain a complete blood count

Correct answer: B

Rationale: The correct answer is to notify the healthcare provider immediately. The child's presentation of sudden, severe abdominal pain in the lower right abdomen is highly concerning for appendicitis, a medical emergency. Promptly notifying the healthcare provider is crucial for further evaluation and management. Administering pain medication as the first action might mask symptoms and delay diagnosis. Starting an IV line for fluid administration and obtaining a complete blood count are important interventions but should come after healthcare provider notification.

3. A 2-year-old is admitted to the hospital with possible encephalitis, and a lumbar puncture is scheduled. Which information should the nurse provide this child concerning the procedure?

• A. Describe the side-lying, knees-to-chest position that must be assumed during the procedure.
• B. Explain that fluids cannot be taken for 8 hours before the procedure and for 4 hours after the procedure.
• C. Reassure the child that there will be no restrictions on activity after the procedure is completed.
• D. Tell the child to expect loud clicking noises during the procedure that may be slightly annoying.

Correct answer: A

Rationale: Children, especially young ones, benefit from knowing what position they will be in during a procedure as it helps them understand and feel more in control. Describing the side-lying, knees-to-chest position can reduce anxiety and promote cooperation during the lumbar puncture. Choice B is incorrect because the question is about preparing the child for the procedure, not about pre-procedure fasting requirements. Choice C is incorrect because there may be restrictions on activity after the procedure. Choice D is incorrect because mentioning loud clicking noises may increase the child's anxiety and fear.

4. Which statement by a school-aged client going to summer camp indicates the best understanding of the mode of transmission of Lyme disease?

• A. I'll cover my mouth with a wet cloth if there's too much dust blowing.
• B. Cuts and scrapes need to be washed out and covered right away.
• C. I'm not going to swim where the water is standing still or feels too hot.
• D. I have to wear long sleeves and pants when we're hiking around the pond.

Correct answer: D

Rationale: The correct answer is D. Wearing long sleeves and pants helps prevent tick bites, which can transmit Lyme disease. Ticks carrying Lyme disease are often found in wooded or grassy areas, so covering exposed skin can reduce the risk of being bitten by an infected tick. Choices A, B, and C do not address the specific mode of transmission of Lyme disease through tick bites, making them incorrect.

5. A 6 year old who has asthma is demonstrating a prolonged expiratory phase and wheezing and has a 35% of personal best peak expiratory flow rate (PEFR). Based on these findings, what actions should the nurse take first?

• A. Administer a prescribed bronchodilator.
• B. Encourage the child to cough and deep breath.
• C. Report findings to the health care provider.
• D. Determine what triggers precipitated this attack.

Correct answer: A

Rationale: Administering a bronchodilator will help open the airways and improve breathing.

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