Nursing Elites

1. A parent arrives in the emergency clinic with a 3-month-old baby who says, “My baby stopped breathing for a while.” The infant continues to have difficulty breathing, with prolonged periods of apnea. Which assessment data should alert the nurse to suspect shaken baby syndrome (SBS)?

• A. Birth occurred before 32 weeks’ gestation
• B. Lack of stridor and adventitious breath sounds
• C. Previous episodes of apnea lasting 10 to 15 seconds
• D. Retractions and use of accessory respiratory muscles

Correct answer: D

Rationale: Retractions and the use of accessory respiratory muscles can be signs of respiratory distress, which may indicate trauma such as shaken baby syndrome (SBS). Shaken baby syndrome can result in brain injury and respiratory compromise, leading to breathing difficulties. Choices A, B, and C are less likely to be associated with SBS. Birth before 32 weeks’ gestation is more related to prematurity rather than SBS. The lack of stridor and adventitious breath sounds, as well as previous episodes of apnea lasting 10 to 15 seconds, are not specific indicators of SBS.

2. A 6-year-old child with asthma is admitted to the hospital with an acute exacerbation. What is the priority nursing intervention?

• A. Administering a bronchodilator
• B. Administering an antihistamine
• C. Administering a corticosteroid
• D. Administering oxygen

Correct answer: A

Rationale: Administering a bronchodilator is the priority intervention for a child experiencing an acute asthma exacerbation. Bronchodilators help to dilate the airways quickly, providing immediate relief by opening up the narrowed air passages in asthma. Antihistamines are not the first-line treatment for asthma exacerbations and may not address the underlying bronchoconstriction. Corticosteroids are important for long-term control of asthma but may take longer to have an effect compared to bronchodilators. Administering oxygen is essential for hypoxemia in asthma exacerbations, but the priority is to relieve bronchoconstriction promptly with a bronchodilator.

3. A 6-year-old child comes to the school nurse reporting a sore throat, and the nurse verifies that the child has a fever and a red, inflamed throat. When a parent of the child arrives at school to take the child home, the nurse urges the parent to seek treatment. The nurse is aware that the causative agent may be beta-hemolytic streptococcus, and the illness may progress to inflamed joints and an infection in the heart. What illness is of most concern to the nurse?

• A. Tetanus
• B. Influenza
• C. Scarlet fever
• D. Rheumatic fever

Correct answer: D

Rationale: Rheumatic fever is the most concerning illness in this case. It can develop as a complication of untreated strep throat caused by beta-hemolytic streptococcus. If not properly treated, rheumatic fever can lead to serious complications such as inflamed joints and heart infections. Tetanus is caused by a toxin produced by Clostridium tetani bacteria and is not related to the symptoms described in the scenario. Influenza is a viral respiratory illness and does not typically lead to rheumatic fever. While scarlet fever is also caused by streptococcus bacteria, in this case, the symptoms described are more indicative of rheumatic fever than scarlet fever.

4. A child is being assessed by a nurse for suspected nephrotic syndrome. What clinical manifestation is the nurse likely to observe?

• A. Jaundice
• B. Edema
• C. Hypertension
• D. Polyuria

Correct answer: B

Rationale: Edema is a hallmark clinical manifestation of nephrotic syndrome. In nephrotic syndrome, there is increased permeability of the glomerular filtration barrier, leading to protein loss in the urine (proteinuria). The decrease in serum protein levels results in a reduced oncotic pressure, leading to fluid shifting from the intravascular space into the interstitial spaces, causing edema. Jaundice (choice A) is not typically associated with nephrotic syndrome. Hypertension (choice C) is more commonly seen in conditions like nephritic syndrome. Polyuria (choice D) is excessive urination and is not a prominent feature of nephrotic syndrome.

5. A child with a diagnosis of appendicitis is scheduled for surgery. What preoperative intervention is important for the nurse to perform?

• A. Administering antibiotics
• B. Maintaining strict NPO status
• C. Encouraging fluid intake
• D. Monitoring for signs of infection

Correct answer: B

Rationale: The correct preoperative intervention for a child with appendicitis scheduled for surgery is maintaining strict NPO (nothing by mouth) status. This is crucial to reduce the risk of aspiration during anesthesia induction and prevent potential complications during surgery. Administering antibiotics may be a part of the treatment plan but is not a preoperative intervention. Encouraging fluid intake is contraindicated preoperatively to avoid delays in surgery and complications related to anesthesia. Monitoring for signs of infection is important postoperatively to assess for any complications that may arise due to the surgical procedure.

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