Nursing Elites

1. An 18-month-old child presents with fever, nasal flaring, intercostal retractions, and a respiratory rate of 50 bpm. What is the most appropriate nursing diagnosis?

• A. High risk for altered body temperature - hyperthermia
• B. Ineffective breathing pattern
• C. Ineffective individual coping
• D. Knowledge deficit

Correct answer: B

Rationale: In this case, the child is showing signs of respiratory distress, such as nasal flaring, intercostal retractions, and an increased respiratory rate. These are indicative of an ineffective breathing pattern. The child's compromised respiratory function requires immediate attention and intervention, making 'Ineffective breathing pattern' the most appropriate nursing diagnosis. Choices A, C, and D do not address the respiratory distress the child is experiencing and are not the priority in this situation.

2. Which of the following statements regarding the length-based resuscitation tape measure is correct?

• A. The resuscitation tape estimates a child's weight based on his or her height.
• B. It is a reliable tool in children who are less than 5 years of age.
• C. The red end of the tape measure is placed at the top of the child's head.
• D. The tape measure can be used in children who weigh up to 75 pounds.

Correct answer: D

Rationale: The length-based resuscitation tape measure is designed to estimate a child's weight based on their length and can be used for children weighing up to 75 pounds. It is a reliable tool for pediatric weight estimation in emergency situations.

3. Which statement best describes direct contact as a mode of pathogen transmission?

• A. Transmission through large aerosols produced by sneezing or coughing
• B. Transfer of an infectious agent by suspended air particles from a reservoir to a host
• C. Transmission of infectious agents carried by dust
• D. Transmission through skin-to-skin contact or body fluids

Correct answer: D

Rationale: Direct contact transmission occurs when pathogens are spread through skin-to-skin contact or body fluids. This mode of transmission includes activities like touching, kissing, or sexual contact where infectious agents can pass directly from one person to another. It does not involve large aerosols, suspended air particles, or dust as carriers of the pathogen.

4. Which of the following is NOT a function of hormones?

• A. Producing new offspring
• B. Promoting growth and beauty
• C. Maintaining body temperature
• D. Fighting infections

Correct answer: A

Rationale: Hormones play various roles in the body, such as promoting growth and beauty, maintaining body temperature, and fighting infections. However, producing new offspring is not a direct function of hormones. Reproduction is primarily regulated by other factors like the reproductive system. Choice B is incorrect because hormones can indeed influence growth but not specifically 'beauty.' Choice C is incorrect as hormones can help regulate body temperature indirectly. Choice D is incorrect as hormones like cytokines can be involved in the body's immune response to fight infections.

5. What should the nurse include in the insulin administration instruction for the parents of a child being discharged on insulin?

• A. Insert the needle and aspirate before injecting
• B. Inject insulin into the extremity to be exercised to improve absorption
• C. The muscles in the abdomen and thigh are the easiest for self-administration
• D. Clean the injection site with soap and water and avoid alcohol

Correct answer: C

Rationale: The correct answer is C because the muscles in the abdomen and thigh are the most suitable areas for self-administration of insulin due to consistent absorption. Choices A and B are incorrect as aspirating before injecting insulin is unnecessary, and injecting into an extremity to be exercised does not enhance absorption. Choice D is incorrect as alcohol should be used to clean the injection site instead of soap and water, which can cause skin irritation.

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