Nursing Elites

1. 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.

2. When caring for a neonate with a suspected tracheoesophageal fistula, what nursing care should be included?

• A. Elevating the head and not giving anything by mouth
• B. Elevating the head at all times
• C. Administering glucose water only during feedings
• D. Avoiding suctioning unless the infant is cyanotic

Correct answer: A

Rationale: When caring for a neonate with a suspected tracheoesophageal fistula, it is essential to elevate the head and avoid giving anything by mouth. Elevating the head helps prevent aspiration, and withholding oral intake reduces the risk of complications like aspiration pneumonia. Elevating the head at all times (choice B) is overly restrictive and unnecessary. Administering glucose water only during feedings (choice C) is not recommended as it can still lead to aspiration. Avoiding suctioning unless the infant is cyanotic (choice D) is incorrect because maintaining airway patency may require suctioning, irrespective of cyanosis, in a neonate with a suspected tracheoesophageal fistula.

3. The parents of an infant ask the nurse why their baby is scheduled to receive the intramuscular polio vaccine rather than the oral vaccine. What is the nurse’s best response?

• A. The American Academy of Pediatrics recommends the intramuscular vaccine because it is safer.
• B. The consensus is that either can be used, since both produce the same results and are equally safe.
• C. The oral vaccine is more expensive, so the intramuscular vaccine is preferred unless it is contraindicated.
• D. The U.S. Centers for Disease Control and Prevention recommends the intramuscular vaccine unless the infant or a family member is immunocompromised.

Correct answer: A

Rationale: The American Academy of Pediatrics recommends the intramuscular polio vaccine because it has a better safety profile compared to the oral vaccine. Choice B is incorrect because the AAP specifically recommends the intramuscular vaccine over the oral vaccine. Choice C is incorrect as cost is not the primary reason for preferring the intramuscular vaccine. Choice D is incorrect as the recommendation is based on safety rather than the immunocompromised status of the infant or family members.

4. The healthcare provider notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of

• A. poor appetite
• B. increased potassium intake
• C. reduction of edema
• D. restriction to bed rest

Correct answer: C

Rationale: In acute glomerulonephritis, weight loss is most likely due to the reduction of edema. Edema is a common symptom of glomerulonephritis, which causes fluid retention and swelling in the body. As treatment progresses and the condition improves, the reduction of edema leads to weight loss. Choices A, B, and D are incorrect as they do not directly address the underlying pathophysiology of acute glomerulonephritis and its impact on weight loss.

5. An 18-month-old was brought to the emergency department by her mother, who states, 'I think she broke her arm.' The child is sent for a radiograph to confirm the fracture. Additional assessment of the child leads the nurse to suspect possible child abuse. Which type of fracture would the radiograph most likely reveal?

• A. Plastic deformity.
• B. Buckle fracture.
• C. Spiral fracture.
• D. Greenstick fracture.

Correct answer: C

Rationale: A spiral fracture is characterized by a twisting injury, often indicating child abuse due to the mechanism involved. This type of fracture is commonly seen in non-accidental trauma cases. Plastic deformity is not typically seen on radiographs but refers to a change in the shape of a bone without breaking. Buckle fractures are incomplete fractures commonly seen in children due to their softer bones. Greenstick fractures are also incomplete fractures, but they do not typically raise suspicion of child abuse as spiral fractures do.

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