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. A child undergoes heart surgery to repair the defects associated with tetralogy of Fallot. What behavior is essential for the nurse to prevent postoperatively?

• A. Crying
• B. Coughing
• C. Straining at stool
• D. Unnecessary movement

Correct answer: C

Rationale: The correct behavior that the nurse needs to prevent postoperatively is straining at stool. Straining at stool should be avoided as it can increase intrathoracic pressure, leading to stress on the surgical site. This stress can potentially compromise the surgical repair and increase the risk of complications. Crying, coughing, and unnecessary movement, although important to monitor postoperatively, do not directly impact the surgical site as significantly as straining at stool does. Therefore, the focus should be on preventing straining at stool to ensure the best postoperative outcome for the child.

3. A nurse is assessing a 10-month-old infant. What developmental milestone should the nurse expect to observe?

• A. Crawling
• B. Sitting without support
• C. Standing with assistance
• D. Pulling to a stand

Correct answer: D

Rationale: The correct answer is D: Pulling to a stand. By 10 months of age, most infants should be able to pull themselves up to a standing position while holding onto furniture or other support. This milestone indicates good strength and coordination in the lower body. Choice A, Crawling, is typically achieved around 6-9 months of age. Choice B, Sitting without support, usually occurs around 6-8 months. Choice C, Standing with assistance, can typically be seen around 9-12 months, but pulling to a stand is a more advanced milestone expected by 10 months.

4. A child with a diagnosis of nephrotic syndrome is being treated with corticosteroids. What is an important nursing consideration?

• A. Monitor for signs of infection
• B. Monitor blood pressure
• C. Monitor for hyperglycemia
• D. Monitor for hypertension

Correct answer: A

Rationale: When a child with nephrotic syndrome is undergoing treatment with corticosteroids, it is crucial to monitor for signs of infection. Corticosteroids can suppress the immune system, increasing the child's susceptibility to infections. Monitoring for signs of infection allows for early detection and prompt intervention, reducing the risk of complications. While monitoring blood pressure (choice B) is important in nephrotic syndrome, it is not the most immediate concern when the child is on corticosteroids. Monitoring for hyperglycemia (choice C) is relevant in corticosteroid therapy, but the priority in this scenario is to watch for signs of infection. Monitoring for hypertension (choice D) is important in nephrotic syndrome but is not the most critical consideration when the child is on corticosteroids.

5. At 0345, you receive a call for a woman in labor. Upon arriving at the scene, you are greeted by a very anxious man who tells you that his wife is having her baby 'now.' This man escorts you into the living room where a 25-year-old woman is lying on the couch in obvious pain. After determining that delivery is not imminent, you begin transport. While en route, the mother tells you that she feels the urge to push. You assess her and see the top of the baby's head bulging from the vagina. What is your most appropriate first action?

• A. allow the head to deliver and check for the location of the cord
• B. advise your partner to stop the ambulance and assist with the delivery
• C. tell the mother to take short, quick breaths until you arrive at the hospital
• D. prepare the mother for an emergency delivery and open the obstetrics kit

Correct answer: B

Rationale: The correct action in this scenario is to advise your partner to stop the ambulance and assist with the delivery. When the mother feels the urge to push and you see the baby's head bulging from the vagina, it indicates an imminent delivery. Stopping the ambulance allows for a safer environment for the delivery of the baby and ensures that immediate assistance can be provided to both the mother and the newborn. Allowing the head to deliver before checking for the cord (Choice A) may delay necessary interventions in case of complications. Instructing the mother to take short, quick breaths (Choice C) is not appropriate when the baby's head is already visible. Preparing for an emergency delivery and opening the obstetrics kit (Choice D) is important but should come after stopping the ambulance and assisting with the imminent birth.

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