Nursing Elites

1. A child with sickle cell anemia develops severe chest pain, fever, a cough, and dyspnea. The nurse's first action is to

• A. administer 100% oxygen to relieve hypoxia
• B. administer pain medication to relieve symptoms
• C. notify the practitioner because chest syndrome is suspected
• D. notify the practitioner because the child may be having a stroke

Correct answer: C

Rationale: In a child with sickle cell anemia experiencing severe chest pain, fever, cough, and dyspnea, the priority action is to suspect acute chest syndrome, a life-threatening complication. The nurse's first action should be to notify the practitioner for immediate evaluation and intervention. Administering 100% oxygen (Choice A) may be necessary later but is not the initial priority. Administering pain medication (Choice B) should not precede notifying the practitioner, as addressing the underlying cause is crucial. The symptoms described are more indicative of acute chest syndrome than a stroke, so notifying the practitioner for chest syndrome (Choice C) takes precedence over suspecting a stroke (Choice D).

2. An infant with a congenital heart defect is being given gavage feedings. The parents ask the nurse why this is necessary. How should the nurse respond?

• A. It limits the chance of vomiting.
• B. It allows the feeding to be administered rapidly.
• C. The energy that would have been expended on sucking is conserved.
• D. The quantity of nutritional liquid can be regulated better than with a bottle.

Correct answer: C

Rationale: Gavage feedings are necessary for infants with congenital heart defects to conserve the infant's energy by eliminating the need for sucking. This is important because sucking requires energy expenditure, which can be taxing for infants with cardiac defects. Choice A is incorrect as gavage feedings do not primarily limit the chance of vomiting. Choice B is incorrect because the speed of feeding administration is not the primary reason for using gavage feedings in this case. Choice D is incorrect as the regulation of the quantity of nutritional liquid is not the main purpose of gavage feedings in infants with congenital heart defects.

3. A parent calls the outpatient clinic requesting information about the appropriate dose of acetaminophen for a 16-month-old child who has signs of an upper respiratory tract infection and fever. The directions on the bottle of acetaminophen elixir are 120 mg every 4 hours when needed. At the toddler’s 15-month visit, the health care provider prescribed 150 mg. What is the nurse’s best response to the parent?

• A. “The dose is close enough, and it doesn’t really matter which one is given.”
• B. “From your description, the medications are not necessary. They should be avoided at this age.”
• C. “It is appropriate to use dosages based on age. Children typically have weights consistent for their age groups.”
• D. “The prescribed dose of the drug was based on weight, and this is a more accurate way of determining a therapeutic dose.”

Correct answer: D

Rationale: The most accurate way to determine a therapeutic dose for children is based on their weight rather than age. Weight-based dosing helps ensure that the child receives the appropriate amount of medication for their body size, which is crucial for safety and effectiveness. Age-based dosing can lead to underdosing or overdosing, as children of the same age can have significantly different weights. Choice A is incorrect because even small variations in dosages can have significant effects on a child's health. Choice B is incorrect as acetaminophen can be appropriate when used correctly for fever management in children. Choice C is incorrect as children's weights can vary greatly within the same age group, making weight-based dosing more precise and individualized.

4. What should the nurse include when teaching an adolescent about tinea pedis?

• A. Keep your feet moist and open to the air as much as possible.
• B. Dry the area between your toes thoroughly.
• C. Wear nylon or synthetic socks every day.
• D. Go barefoot when you are in the school locker room.

Correct answer: B

Rationale: The correct way to prevent tinea pedis is by keeping the feet dry, especially between the toes, to decrease the risk of fungal infection. Choice A is incorrect as keeping the feet moist can promote fungal growth. Choice C is incorrect because nylon or synthetic socks can trap moisture, contributing to the growth of fungi. Choice D is incorrect as going barefoot in public, especially in areas like locker rooms, increases the risk of contracting tinea pedis.

5. During a vaccination drive at a well-child clinic, a nurse observes that a recently hired nurse is not wearing gloves. What should the nurse advise the newly hired nurse to do?

• A. Speak with the nurse manager regarding techniques.
• B. Put on gloves because standard precautions are required.
• C. Continue with the immunizations because gloves are not needed.
• D. Evaluate the child’s appearance to determine whether gloves are needed.

Correct answer: B

Rationale: The correct answer is B: "Put on gloves because standard precautions are required." Standard precautions are essential in healthcare settings to prevent the transmission of infections, and wearing gloves is a crucial part of these precautions during immunizations. Choice A is incorrect because speaking with the nurse manager about techniques does not address the immediate need for wearing gloves. Choice C is incorrect because gloves are indeed needed to prevent the spread of infections. Choice D is incorrect as evaluating the child's appearance is not a substitute for wearing gloves which are a basic infection control measure.

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