Nursing Elites

1. An adolescent female who is leaning forward with her hands on her knees to breathe tells the practical nurse that she has been using triamcinolone (Azmacort) inhalation aerosol before coming to the clinic. Which action should the PN implement?

• A. Obtain vital signs and assess breath sounds for wheezing.
• B. Collect a blood sample for white blood cell count.
• C. Give the client a nebulizer breathing treatment.
• D. Administer another dose of Azmacort.

Correct answer: A

Rationale: When a patient presents with breathing difficulties, the first action should be to assess vital signs and breath sounds to evaluate the severity of the condition. This assessment will provide crucial information to determine the appropriate course of action and treatment. Collecting a blood sample for a white blood cell count, giving a nebulizer treatment, or administering another dose of Azmacort would not be the initial priority in this situation. Therefore, option A is the correct choice as it focuses on assessing the patient's respiratory status to guide further interventions.

2. What information should the nurse provide to parents of a 3-year-old boy with Duchenne muscular dystrophy who inquire about the disease and future children?

• A. This is an inherited X-linked recessive disorder, which primarily affects male children in the family
• B. The striated muscle groups of males can be impacted by a lack of the protein dystrophin in their mothers
• C. The male infant had a viral infection that went unnoticed and untreated so muscle damage was incurred
• D. Birth trauma with a breech vaginal birth causes damage to the spinal cord, thus weakening the muscles

Correct answer: A

Rationale: Duchenne muscular dystrophy is an X-linked recessive disorder caused by mutations in the DMD gene on the X chromosome. This disorder primarily affects males because they have one X chromosome, inherited from their mothers, who may be carriers of the mutated gene. Females have two X chromosomes, providing a protective effect as the normal gene on one X chromosome can compensate for the mutated gene on the other. Therefore, the nurse should explain to the parents that Duchenne muscular dystrophy is an inherited X-linked recessive disorder, which is why their son has the disease and why there is a risk of passing it on to future sons. Choice B is incorrect as it inaccurately implies that the lack of dystrophin in mothers impacts their sons' muscle groups. Choice C is incorrect as it suggests a viral infection caused the muscle damage, which is not the case with Duchenne muscular dystrophy. Choice D is incorrect as it attributes the muscle weakness to birth trauma instead of the genetic nature of the disorder.

3. What recommendation should the PN provide to help a 5-year-old girl who has started wetting the bed again after being dry at night for several months?

• A. Explain that bedwetting is normal in children and will pass with time.
• B. Advise limiting fluids in the evening and before bedtime.
• C. Suggest punishing the child for wetting the bed to prevent recurrence.
• D. Encourage the child to use the bathroom immediately before bed.

Correct answer: D

Rationale: Encouraging the child to use the bathroom before bed is a helpful recommendation to prevent nighttime bedwetting. Bedwetting can sometimes reoccur due to stress or other factors, and ensuring the child empties their bladder before sleeping may reduce the likelihood of bedwetting episodes. Choice A is incorrect because while bedwetting is common in children, it is essential to provide practical solutions rather than just reassurance. Choice B is not the best option for a child who has recently started bedwetting again after being dry, as it may not address the underlying cause. Choice C is inappropriate and harmful as punishing the child for bedwetting can lead to psychological distress and worsen the situation.

4. A 5-year-old child is brought to the emergency department with severe abdominal pain and vomiting. The child’s parent reports that the pain started suddenly and is located in the lower right abdomen. What should the nurse do first?

• A. Administer pain medication
• B. Notify the healthcare provider immediately
• C. Start an IV line for fluid administration
• D. Obtain a complete blood count

Correct answer: B

Rationale: The correct answer is to notify the healthcare provider immediately. The child's presentation of sudden, severe abdominal pain in the lower right abdomen is highly concerning for appendicitis, a medical emergency. Promptly notifying the healthcare provider is crucial for further evaluation and management. Administering pain medication as the first action might mask symptoms and delay diagnosis. Starting an IV line for fluid administration and obtaining a complete blood count are important interventions but should come after healthcare provider notification.

5. The mother calls the clinic and tells the practical nurse (PN) that her child cannot swallow a prescribed tablet that was dispensed by the local pharmacy as a whole tablet. How should the PN respond?

• A. You can crush the tablet and mix it with food.
• B. You should not force the child to swallow the tablets by holding her nose closed.
• C. If a liquid form is available, the pharmacist can be contacted for a prescription change.
• D. Do not advise the child to chew the tablet if she cannot swallow it.

Correct answer: C

Rationale: When a child is unable to swallow a tablet, the appropriate response is to consider if a liquid form of the medication is available. This is a safer and more effective alternative than forcing the child to swallow or chew the tablet. Contacting the pharmacist for a prescription change can provide a suitable solution that ensures the child receives the medication in a more manageable form. Choices A, B, and D are incorrect because crushing the tablet and mixing it with food may alter the medication's effectiveness or taste, forcing the child to swallow or holding her nose closed can be distressing and ineffective, and advising the child to chew the tablet is not recommended as an alternative to swallowing it.

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