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. Which observation made of the exposed abdomen is most indicative of pyloric stenosis?

• A. abdominal rigidity
• B. substernal retraction
• C. palpable olive-like mass
• D. marked distention of lower abdomen

Correct answer: C

Rationale: The correct answer is C: palpable olive-like mass. In pyloric stenosis, a palpable olive-like mass can often be felt in the abdomen due to the hypertrophied pyloric muscle. This mass is a key characteristic finding in infants with pyloric stenosis. Choice A, abdominal rigidity, is more commonly associated with conditions like peritonitis. Choice B, substernal retraction, is not typically seen in pyloric stenosis but can be a sign of respiratory distress. Choice D, marked distention of the lower abdomen, is not specific to pyloric stenosis and can be present in various abdominal conditions.

3. What should an adolescent with type 1 diabetes do if an insulin reaction is experienced while at a basketball game?

• A. Call your parents immediately.
• B. Buy a soda and hamburger to eat.
• C. Administer insulin as soon as possible.
• D. Leave the arena and rest until the symptoms subside.

Correct answer: B

Rationale: Choosing option B, 'Buy a soda and hamburger to eat,' is the most appropriate action for an adolescent with type 1 diabetes experiencing an insulin reaction during a basketball game. In this situation, the individual is likely experiencing hypoglycemia, and consuming a soda provides a quick source of sugar to raise blood glucose levels rapidly. The hamburger can offer a more sustained release of energy due to its protein and fat content. Option A is incorrect because while contacting parents for help may be necessary in some situations, immediate action to address hypoglycemia is crucial. Option C is incorrect because administering insulin would further lower blood sugar levels, worsening the condition. Option D is incorrect as leaving the arena without addressing the hypoglycemia can lead to a worsening of symptoms and potentially dangerous outcomes.

4. A parent asks the nurse what to do when their toddler has temper tantrums. What play materials should the nurse suggest to offer the child as another way of expressing anger?

• A. Ball and bat
• B. Wad of clay
• C. Punching bag
• D. Pegs and pounding board

Correct answer: D

Rationale: Pegs and pounding boards are recommended as play materials for toddlers to express their anger in a constructive manner. These tools provide a safe and effective outlet for the child's emotions through physical activity. Options A, B, and C do not offer the same interactive and expressive qualities that pegs and pounding boards provide. A ball and bat may encourage aggressive behavior, a wad of clay is more suitable for creative expression rather than anger management, and a punching bag may promote violent behavior which is not appropriate for toddlers.

5. Which nursing intervention provides the most support to the parents of an infant with an obvious physical anomaly?

• A. Encourage them to express their concerns.
• B. Discourage them from talking about their baby.
• C. Assure them not to worry because the anomaly can be repaired.
• D. Show them postoperative photographs of infants who had a similar anomaly.

Correct answer: A

Rationale: Encouraging parents to express their concerns is the most supportive intervention because it allows them to process their emotions and provides them with an opportunity to share their fears, anxieties, and questions. This open communication helps the nurse to offer appropriate support, education, and reassurance. Discouraging parents from talking about their baby (Choice B) can hinder their emotional expression and prevent them from seeking necessary information and support. Assuring parents not to worry (Choice C) may invalidate their feelings and minimize the significance of their concerns. Showing postoperative photographs (Choice D) may not be appropriate at this stage as parents need emotional support and education about the current situation before focusing on postoperative outcomes.

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