Nursing Elites

1. A child has been diagnosed with classic hemophilia. A nurse teaches the child’s parents how to administer the plasma component factor VIII through a venous port. It is to be given 3 times a week. What should the nurse tell them about when to administer this therapy?

• A. Whenever a bleed is suspected
• B. In the morning on scheduled days
• C. At bedtime while the child is lying quietly in bed
• D. On a regular schedule at the parents’ convenience

Correct answer: B

Rationale: Administering factor VIII in the morning on scheduled days is the correct choice. This timing ensures that the factor VIII levels remain stable throughout the day when the child is active and at risk of bleeding. Choice A is incorrect because factor VIII should be given on a regular schedule rather than only when a bleed is suspected. Choice C is not ideal as the child may be more active during the day, increasing the risk of bleeding. Choice D is also incorrect as the administration should follow a specific schedule to maintain therapeutic levels of factor VIII in the child's system.

2. After a cardiac catheterization, what is the priority nursing care for a 3-year-old child?

• A. Encouraging early ambulation
• B. Monitoring the site for bleeding
• C. Restricting fluids until the blood pressure is stabilized
• D. Comparing the blood pressure of both lower extremities

Correct answer: B

Rationale: After a cardiac catheterization, the priority nursing care for a 3-year-old child is monitoring the site for bleeding. This is essential to promptly identify and address any signs of bleeding or hematoma formation, which are potential complications of the procedure. Encouraging early ambulation may be beneficial post-procedure but ensuring site integrity takes precedence. Restricting fluids until blood pressure stabilization is not a standard post-catheterization practice, as adequate hydration is crucial for recovery. Comparing the blood pressure of both lower extremities is not a priority immediate nursing action after a cardiac catheterization in a pediatric patient.

3. A mother confides to the nurse that she is thinking of divorce. Which suggestion by the nurse would help minimize the effects on the child?

• A. Tell the child together using appropriate terms.
• B. Reassure the child that no one loves him more than his parents.
• C. Engage in special activities with the child to compensate for the divorce.
• D. Keep your feelings to yourself and maintain a positive facade with the child.

Correct answer: A

Rationale: In situations of divorce, it is crucial for both parents to inform the child together using age-appropriate language. This approach helps maintain consistency and clarity for the child, reducing confusion and anxiety. Choice B is incorrect because reassurance should not be solely focused on love but on explaining the situation appropriately. Choice C may inadvertently send the message that the divorce is the child's fault or requires compensation. Choice D is incorrect as children benefit from understanding and processing emotions in a healthy manner, rather than having them kept hidden.

4. A healthcare provider is assessing a child with suspected rheumatic fever. What clinical manifestation is the provider likely to observe?

• A. Jaundice
• B. Peeling skin on the hands and feet
• C. High fever
• D. Severe joint pain

Correct answer: D

Rationale: Severe joint pain is a classic symptom of rheumatic fever, resulting from inflammation of the joints. Rheumatic fever primarily affects the joints, heart, skin, and the central nervous system. Jaundice (Choice A) is not typically associated with rheumatic fever. Peeling skin on the hands and feet (Choice B) is more characteristic of conditions like Kawasaki disease. While high fever (Choice C) can be present in rheumatic fever, it is not as specific or characteristic as severe joint pain.

5. Parents of a sick infant talk with a nurse about their baby. One parent says, “I am so upset; I didn’t realize our baby was ill.” What major indication of illness in an infant should the nurse explain to the parent?

• A. Grunting respirations
• B. Excessive perspiration
• C. Longer periods of sleep
• D. Crying immediately after feedings

Correct answer: C

Rationale: Longer periods of sleep than usual can be a sign of illness in infants. When an infant sleeps more than usual, it may indicate that the baby is conserving energy due to an underlying condition. Grunting respirations (choice A) can be a sign of respiratory distress, excessive perspiration (choice B) may indicate overheating or fever, and crying immediately after feedings (choice D) can be a sign of gastrointestinal discomfort, such as colic or reflux. However, in this scenario, the emphasis is on changes in sleep patterns as a potential indicator of illness.

Similar Questions