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. 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.

3. When caring for a child experiencing severe asthma symptoms, which medication should the practical nurse anticipate being administered first?

• A. Inhaled corticosteroids.
• B. Oral corticosteroids.
• C. Short-acting beta agonists.
• D. Leukotriene receptor antagonists.

Correct answer: C

Rationale: In the management of acute asthma exacerbations, the first-line medication for quick relief of bronchoconstriction is a short-acting beta agonist, such as albuterol. These medications help to rapidly open up the airways, providing immediate relief to the patient. Inhaled corticosteroids are more commonly used for long-term control of asthma symptoms, while oral corticosteroids and leukotriene receptor antagonists are often reserved for more severe or chronic cases. Therefore, in a child experiencing severe asthma symptoms, the practical nurse should anticipate the administration of short-acting beta agonists as the initial intervention to provide quick relief and improve breathing.

4. A 7-year-old is admitted to the hospital with persistent vomiting, and a nasogastric tube attached to low intermittent suction is applied. Which finding is most important for the nurse to report to the healthcare provider?

• A. Gastric output of 100 mL in the last 8 hours.
• B. Shift intake of 640 mL IV fluids plus 30 mL PO ice chips.
• C. Serum potassium of 3.0 mEq/L.
• D. Serum pH of 7.45.

Correct answer: C

Rationale: A serum potassium level of 3.0 mEq/L is significantly low and indicates hypokalemia, which can lead to serious complications such as cardiac arrhythmias. Therefore, it is crucial for the nurse to report this finding promptly to the healthcare provider for immediate intervention. The other findings are not as critical in this situation. Gastric output of 100 mL in the last 8 hours may be expected in a patient with persistent vomiting. The shift intake of IV fluids and ice chips indicates fluid replacement, which is important but not as urgent as correcting electrolyte imbalances. A serum pH of 7.45 is within the normal range and does not indicate an immediate concern.

5. 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. Tell the child to expect loud clicking noises during the procedure that may be slightly annoying.
• C. Reassure the child that there will be no restrictions on activity after the procedure is completed.
• D. Explain that fluids cannot be taken for 8 hours before the procedure and for 4 hours after the procedure.

Correct answer: A

Rationale: The correct answer is A. Describing the side-lying, knees to chest position that must be assumed during the lumbar puncture procedure is essential as it helps the child understand what to expect, promotes cooperation, and reduces anxiety. This position is necessary for the procedure to be performed safely and effectively. Choice B is incorrect because mentioning loud clicking noises may increase the child's anxiety. Choice C is incorrect because there may be restrictions on activity after the procedure, depending on individual cases. Choice D is also incorrect as it provides information about fluid intake restrictions that are not directly related to the procedure itself.

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