Nursing Elites

1. During a vaso-occlusive crisis in sickle cell anemia, what action is crucial for a nurse to take?

• A. Administer meperidine for pain.
• B. Apply cold compresses to the child's joints.
• C. Limit the child's fluid intake.
• D. Maintain bed rest for the child.

Correct answer: D

Rationale: During a vaso-occlusive crisis in sickle cell anemia, maintaining bed rest is crucial to reduce oxygen consumption and alleviate pain. Movement can worsen the crisis by increasing sickling of red blood cells, leading to further tissue damage and pain. Bed rest helps to improve blood flow, reduce pain, and promote healing. Administering meperidine for pain (Choice A) is not recommended due to the risk of normeperidine accumulation and potential neurotoxicity. Applying cold compresses (Choice B) may cause vasoconstriction, worsening the vaso-occlusive crisis. Limiting fluid intake (Choice C) is not appropriate as adequate hydration is essential to prevent dehydration and maintain blood flow.

2. Which clinical manifestations should the nurse anticipate upon assessment for a preschool-age child with a urinary tract infection (UTI)?

• A. Headache, hematuria, and vertigo
• B. Foul-smelling urine, elevated blood pressure (BP), and hematuria
• C. Urgency, dysuria, and fever
• D. Severe flank pain, nausea, and headache

Correct answer: C

Rationale: Preschool-age children with a urinary tract infection commonly present with urgency (feeling the need to urinate urgently), dysuria (painful urination), and fever. These symptoms are indicative of a UTI in this age group and should prompt further assessment and intervention by the nurse. Choice A is incorrect because headache and vertigo are not typical symptoms of UTI in preschool-age children. Choice B is incorrect because while foul-smelling urine and hematuria can be present in UTI, elevated blood pressure is not a common finding in this condition. Choice D is incorrect as severe flank pain and nausea are not typical manifestations of UTI in preschool-age children.

3. A nurse is providing discharge teaching to the parent of a child who has juvenile idiopathic arthritis. Which of the following statements should the nurse include?

• A. Encourage the child to sleep for 8 hours each night.
• B. Perform range-of-motion exercises once per week.
• C. Give your child NSAIDs on a regular schedule.
• D. Apply heat to the child's affected joints twice daily.

Correct answer: C

Rationale: The nurse should instruct the parent to give the child NSAIDs on a regular schedule to maintain therapeutic levels and control pain.

4. When the home health nurse visits the home of a 10-month-old child, she observes the environment for risks of injury to the child. Which observation will the nurse discuss with the mother?

• A. The mother leaves the filled mop bucket on the floor while in another room.
• B. The mother turns all pan handles to the back of the stove.
• C. The mother fills the bathtub before bringing the baby into the bathroom.
• D. When riding in a car, the child is in a car seat in the middle of the back seat.

Correct answer: A

Rationale: The correct answer is A because leaving a filled mop bucket on the floor poses a drowning hazard for a 10-month-old child. Water in the bucket can be a potential drowning risk if the child falls into it. Pan handles turned to the back of the stove prevent accidental spills or burns, which is a safety measure in the kitchen. Filling the bathtub before bringing the baby into the bathroom helps in preventing burns from hot water. Placing the child in a car seat in the middle of the back seat provides safety by minimizing the risk of injury during a car ride, but it is not the most immediate risk to address in the scenario provided.

5. The healthcare provider is assessing an infant brought to the clinic due to diarrhea. The infant is alert but has dry mucous membranes. Which additional assessment data indicates to the healthcare provider that the infant is experiencing an early to moderate stage of dehydration?

• A. Bradycardia
• B. Tachycardia
• C. Increased blood pressure
• D. Normal fontanels

Correct answer: B

Rationale: Tachycardia is a common early sign of dehydration in infants, especially when presenting with dry mucous membranes and diarrhea. The increased heart rate is the body's compensatory mechanism to maintain cardiac output in response to dehydration. Bradycardia, increased blood pressure, and normal fontanels are not typically associated with early to moderate dehydration in infants.

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