Nursing Elites

1. A 7-year-old child with a history of asthma presents to the clinic with shortness of breath and wheezing. The nurse notes that the child’s peak flow reading is in the red zone. What should the nurse do first?

• A. Administer a bronchodilator
• B. Reassess the peak flow reading
• C. Notify the healthcare provider
• D. Provide oxygen therapy

Correct answer: A

Rationale: When a child with asthma presents with shortness of breath and wheezing, and the peak flow reading is in the red zone, indicating severe airflow limitation, the priority intervention is to administer a bronchodilator. Bronchodilators help dilate the airways quickly, improving airflow and assisting with breathing. Reassessing the peak flow reading is important but not the first action to take in a severe asthma exacerbation. Notifying the healthcare provider can be done after initiating immediate treatment with a bronchodilator. Providing oxygen therapy may be needed in some cases, but addressing the airway constriction with a bronchodilator should come first to improve ventilation.

2. When developing a behavior modification program for an extremely aggressive 10-year-old boy, what should the nurse do first?

• A. Determine what activities, foods, and toys the child enjoys
• B. Evaluate the child’s previous reactions to punishment
• C. Provide the child with positive feedback
• D. Encourage other children on the unit to describe the token system

Correct answer: A

Rationale: The first step in developing a behavior modification program for an aggressive child is to determine what activities, foods, and toys the child enjoys. Understanding the child's preferences allows the nurse to personalize the program, making it more engaging and effective. This approach increases the chances of success in modifying the aggressive behavior. Evaluating previous reactions to punishment (Choice B) may be important but comes later in the process. Providing positive feedback (Choice C) is beneficial but should come after tailoring the program. Encouraging other children to describe the token system (Choice D) is not the initial step; the focus should be on individualizing the program for the specific child first.

3. Which nursing diagnosis is a priority for a 4-year-old child diagnosed with nephrotic syndrome?

• A. Impaired urinary elimination.
• B. Risk for infection.
• C. Fluid volume excess.
• D. Risk for impaired skin integrity.

Correct answer: C

Rationale: In a child with nephrotic syndrome, fluid volume excess is a priority nursing diagnosis due to the risk of edema and related complications. This patient may experience significant fluid retention, leading to edema, hypertension, and potential respiratory distress. Monitoring and managing fluid volume excess are crucial in preventing further complications and supporting the child's health during nephrotic syndrome. The other options are not the priority in this case. Impaired urinary elimination is not typically a primary concern in nephrotic syndrome. While infection is a risk due to compromised immunity, fluid volume excess poses a more immediate threat to the child's health. Risk for impaired skin integrity may be a concern secondary to edema, but addressing fluid volume excess takes precedence.

4. When a 3-year-old boy asks a nurse why his baby sister is eating his mommy’s breast, how should the nurse respond? (Select the response that does not apply.)

• A. Remind him that his mother breastfed him too
• B. Clarify that breastfeeding is the mother’s choice
• C. Reassure the older brother that it does not hurt his mother
• D. Explain that newborns get milk from their mothers in this way

Correct answer: A

Rationale: In this scenario, the nurse should avoid reminding the older sibling about his own breastfeeding experience as it does not directly address the question posed by the boy. Providing simple explanations about breastfeeding and newborn feeding patterns helps the older sibling understand the natural process without bringing up personal experiences. Choice B is correct because clarifying that breastfeeding is the mother's choice helps the older sibling understand the concept of personal decisions. Choice C is appropriate as reassuring the older brother that it does not hurt his mother addresses a common concern children may have. Choice D is also suitable as it explains in simple terms how newborns receive milk from their mothers.

5. The practical nurse is caring for a child with suspected appendicitis. Which assessment finding should be reported to the healthcare provider immediately?

• A. Nausea and vomiting.
• B. Sudden relief of pain.
• C. Low-grade fever.
• D. Rebound tenderness.

Correct answer: B

Rationale: Sudden relief of pain in a child with suspected appendicitis should be reported immediately as it may indicate a rupture of the appendix, which is a medical emergency. Sudden relief of pain is concerning because it can be a sign of a perforated appendix, leading to peritonitis and sepsis.

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