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 child with acute lymphocytic leukemia (ALL) who is receiving chemotherapy via a subclavian IV infusion has an oral temperature of 103 degrees. In assessing the IV site, the nurse determines that there are no signs of infection at the site. Which intervention is the most important for the nurse to implement?

• A. Obtain a specimen for blood cultures.
• B. Assess the CBC.
• C. Monitor the oral temperature every hour.
• D. Administer acetaminophen as prescribed.

Correct answer: A

Rationale: Obtaining a specimen for blood cultures is crucial in this situation as it helps identify the source of infection, if present, and guide appropriate treatment. This is important in a child with leukemia receiving chemotherapy to prevent potential complications and ensure timely intervention. Assessing the CBC may provide overall information on the child's condition but may not specifically identify a potential infection. Monitoring the oral temperature is important but obtaining blood cultures takes precedence in this scenario. Administering acetaminophen can help reduce fever but does not address the need to identify a possible infection source.

3. The nurse is caring for a 14-year-old adolescent who was admitted to the hospital after a suicide attempt. The adolescent’s mood appears stable, and the healthcare provider has recommended discharge. What is the nurse’s priority action?

• A. Ensure that a safety plan is in place before discharge
• B. Provide education about medication adherence
• C. Encourage the adolescent to participate in group therapy
• D. Schedule a follow-up appointment with a mental health professional

Correct answer: A

Rationale: The priority action for the nurse is to ensure that a safety plan is in place before discharge. A safety plan is essential to assist the adolescent in managing future crises and decreasing the likelihood of another suicide attempt. It provides guidance on coping strategies and resources to help the adolescent stay safe in times of distress.

4. A 4-year-old child is brought to the clinic with complaints of ear pain and fever. The practical nurse suspects otitis media. Which symptom supports this suspicion?

• A. Clear nasal discharge.
• B. Dry, hacking cough.
• C. Tugging at the ear.
• D. Sore throat.

Correct answer: C

Rationale: Tugging at the ear is a common symptom in children with otitis media. It often indicates discomfort or pain in the ear, suggesting inflammation or infection in the middle ear. This behavior is frequently observed in young children who are unable to express their discomfort verbally, making it a significant clinical indicator for otitis media in this age group. Clear nasal discharge (Choice A) is more indicative of a cold or allergies, while a dry, hacking cough (Choice B) is not typically associated with otitis media. Although a sore throat (Choice D) can sometimes accompany ear infections, tugging at the ear is a more specific and reliable symptom in this case.

5. 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.

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