Nursing Elites

1. When planning care for a child diagnosed with rheumatic fever, what is the primary goal of nursing care?

• A. Reduce fever.
• B. Maintain fluid and electrolyte balance.
• C. Prevent cardiac damage.
• D. Maintain joint mobility and function.

Correct answer: C

Rationale: The primary goal of nursing care for a child diagnosed with rheumatic fever is to prevent cardiac damage. Rheumatic fever can lead to complications affecting the heart, making it crucial to monitor and prevent cardiac involvement to avoid long-term consequences. While addressing fever and joint pain are important aspects of care, preventing cardiac damage takes precedence in managing rheumatic fever. Therefore, choices A, B, and D are not the primary goals of nursing care in this case.

2. The healthcare provider is preparing to administer a scheduled dose of digoxin to a 4-year-old child with heart failure. The healthcare provider notes that the child’s heart rate is 70 beats per minute. What should the healthcare provider do next?

• A. Administer the medication as prescribed
• B. Hold the medication and notify the healthcare provider
• C. Recheck the heart rate in 30 minutes
• D. Administer half of the prescribed dose

Correct answer: B

Rationale: In pediatric patients, digoxin administration is guided by the heart rate. If the child's heart rate is below the established threshold, which is typically 90-100 beats per minute in a 4-year-old, the medication should be withheld, and the healthcare provider should be notified for further evaluation and instructions. Choice A is incorrect because administering the medication when the heart rate is low can lead to adverse effects. Rechecking the heart rate in 30 minutes (Choice C) may delay necessary intervention if the heart rate remains low. Administering half of the prescribed dose (Choice D) is not recommended without healthcare provider guidance.

3. The nurse is assessing a 4-year-old child who is brought to the clinic for a routine checkup. The child’s parent reports that the child has been more irritable and less active over the past week. The nurse notes a petechial rash on the child’s trunk and extremities. What should the nurse do first?

• A. Ask the parent about recent exposure to contagious diseases
• B. Review the child’s immunization record
• C. Measure the child’s temperature
• D. Notify the healthcare provider immediately

Correct answer: D

Rationale: In this scenario, the child's presentation with irritability, decreased activity, and a petechial rash raises concern for a serious condition like meningitis. Petechial rash can be indicative of meningitis or other critical illnesses. Therefore, the nurse's priority should be to notify the healthcare provider immediately to ensure prompt evaluation and appropriate management. Asking about recent exposure to contagious diseases may be relevant later but is not the most urgent action. Reviewing the child's immunization record and measuring the temperature can provide valuable information but should not take precedence over the need to address the potential serious condition indicated by the petechial rash.

4. A mother brings her 2-year-old son to the clinic because he has been crying and pulling on his earlobe for the past 12 hours. The child's oral temperature is 101.2°F. Which intervention should the nurse implement?

• A. Ask the mother if the child has had a runny nose
• B. Cleanse purulent exudate from the affected ear canal
• C. Apply a topical antibiotic to the periauricular area
• D. Provide parent education to prevent recurrence

Correct answer: A

Rationale: In a child presenting with ear pain and fever, asking if the child has had a runny nose is crucial in assessing possible causes of an ear infection. Respiratory infections can lead to secondary ear infections, so exploring symptoms related to upper respiratory tract infections, like a runny nose, can help in the evaluation and management of the child's condition. Choice B is incorrect because cleansing purulent exudate should be done by a healthcare provider, not a nurse, and only if necessary. Choice C is incorrect because applying a topical antibiotic without proper evaluation and prescription is not within the nurse's scope of practice. Choice D is incorrect because while parent education may be necessary, addressing the immediate concern of evaluating possible causes of the ear pain and fever takes priority.

5. A two-year-old child with heart failure is admitted for replacement of a graft for coarctation of the aorta. Prior to administering the next dose of digoxin (Lanoxin), the nurse obtains an apical heart rate of 128 bpm. What action should the nurse take?

• A. Determine the pulse deficit.
• B. Administer the scheduled dose.
• C. Calculate the safe dose range.
• D. Review the serum digoxin level.

Correct answer: B

Rationale: Administering the scheduled dose is appropriate in this scenario as the heart rate of 128 bpm falls within the acceptable range for a two-year-old child with heart failure. It indicates that the child may benefit from the therapeutic effects of digoxin. Monitoring the heart rate closely after administration is essential to ensure the medication's effectiveness and safety. Determining the pulse deficit (Choice A) is not necessary in this situation as the heart rate is within the acceptable range. Calculating the safe dose range (Choice C) is not needed since the heart rate is already within the expected parameters. Reviewing the serum digoxin level (Choice D) is not the immediate action required in this case where the heart rate is within the normal range.

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