Nursing Elites

1. A child with sickle cell anemia is being treated for a vaso-occlusive crisis. Which intervention should the practical nurse (PN) implement?

• A. Apply cold packs to painful areas.
• B. Encourage increased fluid intake.
• C. Administer high doses of vitamin C.
• D. Provide low-calorie meals.

Correct answer: B

Rationale: Encouraging increased fluid intake is crucial in managing vaso-occlusive crises in patients with sickle cell anemia. Dehydration can worsen these crises, so adequate hydration is essential to prevent complications and improve outcomes. Applying cold packs to painful areas may exacerbate vaso-occlusive crises by causing vasoconstriction. Administering high doses of vitamin C is not directly indicated for vaso-occlusive crises in sickle cell anemia. Providing low-calorie meals is not the priority during a vaso-occlusive crisis; maintaining adequate nutrition is important, but hydration takes precedence in this situation.

2. A 15-month-old child is brought to the clinic for a routine checkup. The nurse notes that the child is not walking independently yet. What should the nurse do next?

• A. Refer the child for a developmental assessment
• B. Encourage the parents to start physical therapy
• C. Reassure the parents that some children walk later than others
• D. Discuss the importance of early intervention services

Correct answer: C

Rationale: The correct answer is to reassure the parents that some children walk later than others. It is essential to understand that children reach developmental milestones at different ages. Walking independently can occur later in some children, and it is normal. Referring the child for a developmental assessment (Choice A) may cause unnecessary concern at this stage. Encouraging physical therapy (Choice B) or discussing early intervention services (Choice D) may not be warranted unless there are specific concerns identified during the checkup.

3. A 16-year-old female student with a history of asthma controlled with both an oral antihistamine and an albuterol (Proventil) metered-dose inhaler (MDI) comes to the school nurse. The student complains that she cannot sleep at night, feels shaky and her heart feels like it is 'beating a mile a minute.' Which information is most important for the nurse to obtain?

• A. When she last took the antihistamine.
• B. When her last asthma attack occurred.
• C. Duration of most asthma attacks.
• D. How often the MDI is used daily.

Correct answer: D

Rationale: The most important information for the nurse to obtain in this scenario is how often the MDI is used daily. This is crucial to assess if the symptoms the student is experiencing, such as insomnia, shakiness, and tachycardia, could be related to overuse of the inhaler. Overuse of albuterol can lead to side effects like tremors, palpitations, and difficulty sleeping, so understanding the frequency of MDI use is key in determining a potential cause for the student's symptoms. Options A, B, and C are not as pertinent in this situation as they do not directly address the possible link between the student's symptoms and the use of the albuterol MDI.

4. A 10-year-old child with hemophilia is admitted to the hospital with joint pain and swelling. What should the healthcare provider do first?

• A. Apply ice to the affected joint
• B. Administer pain medication
• C. Elevate the affected limb
• D. Administer factor VIII as prescribed

Correct answer: D

Rationale: Administering factor VIII as prescribed is the priority intervention for a child with hemophilia experiencing joint pain and swelling. Hemophilia is a genetic disorder that impairs the blood's ability to clot properly, leading to prolonged bleeding. Factor VIII replacement therapy is essential as it helps restore the missing clotting factor in patients with hemophilia, thereby aiding in clot formation and preventing further bleeding. Applying ice, administering pain medication, or elevating the limb may be supportive measures but addressing the underlying cause by providing factor VIII therapy takes precedence in managing hemophilia-related joint pain and swelling.

5. How should the caregiver instruct on caring for a 4-month-old with seborrheic dermatitis (cradle cap) when shampooing the child's hair?

• A. Use a soft brush and gently scrub the area.
• B. Avoid scrubbing the scalp until the scales disappear.
• C. Avoid washing the child's hair more than once a week.
• D. Use soap and water and avoid shampoos.

Correct answer: A

Rationale: When dealing with seborrheic dermatitis (cradle cap) in infants, it is essential to use a soft brush and gently scrub the affected area to help remove the scales. This process can aid in managing the condition and preventing further build-up. It is important to be gentle to avoid irritating the baby's delicate skin. Choice B is incorrect as gentle scrubbing with a soft brush can help in the removal of scales. Choice C is incorrect because regular but gentle washing is recommended to manage cradle cap. Choice D is incorrect as using specialized shampoos designed for cradle cap is usually recommended over soap and water.

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