Nursing Elites

1. What is the priority nursing intervention for a child with juvenile idiopathic arthritis (JIA)?

• A. Encouraging a diet high in protein
• B. Administering nonsteroidal anti-inflammatory drugs (NSAIDs)
• C. Applying heat to affected joints
• D. Providing range-of-motion exercises

Correct answer: B

Rationale: The priority nursing intervention for a child with juvenile idiopathic arthritis (JIA) is to administer nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs help manage pain and inflammation associated with JIA, making them crucial in providing relief to the child. Encouraging a diet high in protein (Choice A) may be beneficial for overall health but is not the priority in managing JIA symptoms. Applying heat to affected joints (Choice C) can provide comfort but does not address the underlying inflammation. Providing range-of-motion exercises (Choice D) is important for maintaining joint mobility but is not the priority intervention when managing acute symptoms of JIA.

2. 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. Which of the following statements regarding crowning is true?

• A. Crowning represents the end of the second stage of labor.
• B. Crowning always occurs immediately after the amniotic sac has ruptured.
• C. It is safe to transport the patient during crowning if the hospital is close.
• D. Gentle pressure should be applied to the baby's head during crowning.

Correct answer: D

Rationale: During crowning, it is important to apply gentle pressure to the baby's head. This helps to prevent rapid delivery, which can lead to tearing and other complications for both the mother and the baby. Applying pressure also helps to control the delivery process, ensuring a safer and more controlled birth. Choices A, B, and C are incorrect because crowning does not signify the end of the second stage of labor, does not always occur immediately after the amniotic sac ruptures, and it is not safe to transport the patient during crowning, especially if the hospital is nearby, as rapid delivery can occur.

3. A nurse is caring for an infant born with exstrophy of the bladder. What does the nurse determine is the greatest risk for this infant?

• A. Infection
• B. Dehydration
• C. Urinary retention
• D. Intestinal obstruction

Correct answer: A

Rationale: Infection is the greatest risk for an infant with exstrophy of the bladder due to the exposure of the bladder and surrounding tissues. The bladder mucosa and adjacent tissues being exposed increase the susceptibility to infections. Dehydration (Choice B) is not the primary concern in this condition. Urinary retention (Choice C) is less likely as exstrophy of the bladder usually presents with constant dribbling of urine. Intestinal obstruction (Choice D) is not directly related to exstrophy of the bladder.

4. You are managing a 10-month-old infant who has had severe diarrhea and vomiting for 3 days and is now showing signs of shock. You have initiated supplemental oxygen therapy and elevated the lower extremities. En route to the hospital, you note that the child's work of breathing has increased. What must you do first?

• A. Lower the extremities and reassess the child
• B. Begin positive pressure ventilations and reassess the child
• C. Place a nasopharyngeal airway and increase the oxygen flow
• D. Listen to the lungs with a stethoscope for abnormal breath sounds

Correct answer: A

Rationale: In this scenario, the infant is showing signs of shock with increased work of breathing. Lowering the extremities helps improve venous return to the heart, cardiac output, and oxygenation by reducing the pressure on the diaphragm. This action can alleviate the respiratory distress and is a critical step to take in a child with signs of shock. Beginning positive pressure ventilations (Choice B) should be considered if the infant's respiratory distress worsens despite lowering the extremities. Placing a nasopharyngeal airway and increasing oxygen flow (Choice C) may not directly address the increased work of breathing or the underlying shock condition. Listening to the lungs with a stethoscope (Choice D) may provide information on lung sounds but does not address the immediate need to improve breathing in a child with signs of shock.

5. What is an early sign of congestive heart failure that the nurse should recognize?

• A. tachypnea
• B. bradycardia
• C. inability to sweat
• D. increased urinary output

Correct answer: A

Rationale: Tachypnea is an early sign of congestive heart failure that nurses should recognize. Tachypnea refers to rapid breathing, which can be an indication of the body's attempt to compensate for decreased cardiac output in congestive heart failure. Bradycardia (choice B) is a slow heart rate and is not typically associated with congestive heart failure. Inability to sweat (choice C) and increased urinary output (choice D) are not specific early signs of congestive heart failure and are not typically recognized as such.

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