Nursing Elites

1. A child with a diagnosis of leukemia is admitted to the hospital with a fever. What is the priority nursing intervention?

• A. Administering antibiotics
• B. Administering antipyretics
• C. Providing nutritional support
• D. Monitoring for signs of infection

Correct answer: D

Rationale: The correct answer is D: Monitoring for signs of infection. When a child with leukemia presents with a fever, the priority nursing intervention is to monitor for signs of infection due to the immunocompromised state of the child. Administering antibiotics (choice A) may be necessary based on the assessment of signs of infection, but monitoring comes first. Administering antipyretics (choice B) helps to reduce fever but does not address the underlying cause. Providing nutritional support (choice C) is essential but not the priority when the child is at risk of infection.

2. Seizures in children most often result from

• A. an abrupt rise in body temperature
• B. an inflammatory process in the brain
• C. a temperature greater than 102°F
• D. a life-threatening infection

Correct answer: A

Rationale: Seizures in children most often result from an abrupt rise in body temperature, leading to febrile seizures. Febrile seizures are common in young children and are typically triggered by a rapid increase in body temperature, often due to infections or other causes. An inflammatory process in the brain (Choice B) is less common as a cause of seizures in children and is usually associated with specific conditions like encephalitis or meningitis. While a temperature greater than 102°F (Choice C) may trigger a febrile seizure, it is the abrupt rise in temperature that is the primary cause. Choice D, a life-threatening infection, is a broad and less specific cause compared to the direct trigger of an abrupt rise in body temperature.

3. You are called to a residence for a "sick" 5-year-old child. When you arrive and begin your assessment, you note that the child is unconscious with a respiratory rate of 8 breaths/min and a heart rate of 50 beats/min. Management of this child should consist of

• A. 100% oxygen via a non-rebreathing mask and rapid transport
• B. positive pressure ventilations with a BVM device and rapid transport
• C. chest compressions, artificial ventilations, and rapid transport
• D. back blows and chest thrusts while attempting artificial ventilations

Correct answer: C

Rationale: In a pediatric patient with an unconscious state, a respiratory rate of 8 breaths/min, and a heart rate of 50 beats/min, the appropriate management involves chest compressions, artificial ventilations, and rapid transport. These signs indicate severe respiratory and circulatory compromise, requiring immediate intervention to support breathing and circulation. Choice A (100% oxygen via a non-rebreathing mask) is not sufficient in this critical situation as the child requires more than just oxygen supplementation. Choice B (positive pressure ventilations with a BVM device) may be needed, but chest compressions are crucial in this scenario due to the presence of bradycardia. Choice D (back blows and chest thrusts) are not indicated for an unconscious child with respiratory and circulatory compromise; instead, immediate chest compressions are necessary to provide circulatory support.

4. The nurse is teaching a parent group about the reasons for adhering to the immunization schedule. What complication of mumps is important for adolescents to avoid?

• A. Sterility
• B. Hypopituitarism
• C. Decrease in libido
• D. Decrease in androgens

Correct answer: A

Rationale: The correct answer is A: Sterility. Mumps can lead to serious complications such as sterility, especially in adolescent males. Vaccination is essential to prevent this potential outcome. Hypopituitarism (Choice B) is not a typical complication of mumps. Choices C and D, decrease in libido and decrease in androgens, are not directly associated with mumps complications, particularly in the context of adolescents.

5. An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 p.m. The fracture was reduced in the emergency department and her arm placed in a cast. At 11 p.m. her mother brings her back to the emergency department due to unrelenting pain that has not been relieved by the prescribed narcotics. Which action would be the priority?

• A. Notifying the doctor immediately
• B. Applying ice
• C. Elevating the arm
• D. Giving additional pain medication as ordered

Correct answer: A

Rationale: The correct action would be to notify the doctor immediately. Unrelenting pain despite medication can indicate compartment syndrome, which is a medical emergency requiring immediate attention. Applying ice, elevating the arm, or giving additional pain medication may not address the underlying cause of the unrelenting pain, which could be a sign of a serious complication like compartment syndrome. Prompt medical evaluation is crucial in this situation to prevent potential complications.

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