Nursing Elites

1. A child with a fever is prescribed acetaminophen. What should the caregiver teach the parents about administering this medication?

• A. Administer the medication with food
• B. Measure the dose with a household spoon
• C. Measure the dose with a proper measuring device
• D. Administer the medication only when the child has a high fever

Correct answer: C

Rationale: The correct answer is to measure the dose with a proper measuring device. Using a household spoon can lead to inaccurate dosing, which can be dangerous. Administering the medication with food or only when the child has a high fever are not the essential instructions related to the safe and effective administration of acetaminophen.

2. What clinical manifestation of tetralogy of Fallot should the nurse expect when caring for children with this diagnosis?

• A. Slow respirations
• B. Clubbing of fingers
• C. Decreased RBC counts
• D. Subcutaneous hemorrhages

Correct answer: B

Rationale: The correct answer is B: Clubbing of fingers. Clubbing of fingers is a common manifestation in children with tetralogy of Fallot due to chronic hypoxia. This condition causes the fingertips and nails to enlarge, creating a bulbous or club-like appearance. Slow respirations (Choice A) are not a typical clinical manifestation of tetralogy of Fallot. Decreased RBC counts (Choice C) may be seen in conditions like anemia but are not specific to tetralogy of Fallot. Subcutaneous hemorrhages (Choice D) are not a characteristic clinical manifestation of tetralogy of Fallot.

3. A nurse is caring for a child with a diagnosis of acute lymphoblastic leukemia (ALL). What is the priority nursing intervention?

• A. Administering chemotherapy
• B. Preventing infection
• C. Monitoring for signs of bleeding
• D. Providing nutritional support

Correct answer: A

Rationale: The correct answer is A: Administering chemotherapy. In the care of a child with acute lymphoblastic leukemia (ALL), the priority nursing intervention is administering chemotherapy. Chemotherapy is the primary treatment for ALL and plays a crucial role in managing the disease. While preventing infection, monitoring for signs of bleeding, and providing nutritional support are important aspects of caring for a child with ALL, administering chemotherapy takes precedence as it directly targets the cancer cells and aims to induce remission.

4. A parent asks the nurse what to do for their child who has an earache and fever. What should the nurse suggest?

• A. Applying a warm compress to the affected ear
• B. Giving the child a cold drink
• C. Administering acetaminophen
• D. Taking the child to the emergency department

Correct answer: A

Rationale: Applying a warm compress to the affected ear is a recommended home remedy for earaches as it can help reduce pain and discomfort. The warmth can also help improve circulation and promote drainage if there is fluid buildup. Giving a cold drink (Choice B) is not typically beneficial for earaches and fever. Administering acetaminophen (Choice C) can help reduce fever and alleviate pain, but addressing the earache directly with a warm compress is a more targeted approach. Taking the child to the emergency department (Choice D) is not necessary for a common earache unless there are severe symptoms or complications present.

5. While waiting for the administration of air pressure to reduce the intussusception, the boy passes a normal brown stool. Which nursing action is the most appropriate for the nurse to take?

• A. notify the practitioner
• B. measure abdominal girth
• C. auscultate for bowel sounds
• D. take vital signs, including blood pressure

Correct answer: A

Rationale: The correct answer is to notify the practitioner. The passage of a normal brown stool in a child with intussusception could indicate spontaneous reduction of the intussusception. It is crucial to inform the practitioner immediately so that they can reassess the situation and determine the next steps, which may include adjusting the planned intervention. Measuring abdominal girth (choice B) may be important in assessing for abdominal distension but is not the most immediate action required in this scenario. Auscultating for bowel sounds (choice C) is a routine nursing assessment but does not take precedence over notifying the practitioner in this critical situation. Taking vital signs, including blood pressure (choice D), is also important but notifying the practitioner is more urgent to address the unexpected change in the patient's condition.

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