Nursing Elites

1. Why is honest information important in building a trusting relationship with adolescent patients?

• A. Encourage the adolescent to seek help outside of the school clinic.
• B. Keep disclosures from the adolescent confidential.
• C. Honest information ensures establishing a trusting relationship.
• D. Discourage minor adolescents from disclosing private concerns.

Correct answer: C

Rationale: Honesty is fundamental in building trust with adolescent patients as it helps create an environment where they feel safe to share their concerns openly. By being honest and maintaining confidentiality, healthcare providers can establish a strong and trusting relationship with adolescents, ultimately leading to better healthcare outcomes.

2. A 2-year-old child with heart failure (HF) is admitted for replacement of a graft for coarctation of the aorta. Prior to administering the next dose of digoxin (Lanoxin), the nurse obtains an apical heart rate of 128 bpm. What action should the nurse take?

• A. Determine the pulse deficit.
• B. Administer the scheduled dose.
• C. Calculate the safe dose range.
• D. Review the serum digoxin level.

Correct answer: B

Rationale: Administering the scheduled dose is appropriate in this scenario since the heart rate of 128 bpm is within an acceptable range for a 2-year-old child with heart failure. Monitoring for signs of digoxin toxicity is important; however, the immediate action required is to administer the scheduled dose as prescribed based on the heart rate assessment.

3. A middle school student was recently diagnosed with attention-deficit hyperactivity disorder (ADHD) and is having trouble with his grades. He is referred to the school nurse by the teacher because he continues to have learning problems. Which action should the school nurse take?

• A. Ask the parents to have the child seen by a clinical psychologist
• B. Ask the parents to become involved in helping the child with his homework
• C. Refer the child to the school counselor for educational testing
• D. Seek the advice of the school principal regarding the child's learning needs

Correct answer: C

Rationale: Referring the child to the school counselor for educational testing is the most appropriate action in this scenario. This step can help identify the specific learning needs of the student and determine the appropriate interventions required to support his academic success. Option A is not the immediate action needed but may be considered in the future. Option B focuses on homework assistance, which may not address the underlying learning problems. Option D involves consulting the school principal, which is not the primary role in addressing the student's learning needs.

4. While assessing the vital signs of a 10-year-old who underwent a tonsillectomy this morning, the nurse observes the child swallowing every 2-3 minutes. Which assessment should the nurse implement?

• A. Inspect the posterior oropharynx
• B. Assess for teeth clenching or grinding
• C. Touch the tonsillar pillars to stimulate the gag reflex
• D. Ask the child to speak to evaluate a change in voice tone

Correct answer: A

Rationale: Frequent swallowing post-tonsillectomy may indicate bleeding. Inspecting the posterior oropharynx is essential to assess for any signs of bleeding, such as fresh blood or clots, which may necessitate immediate intervention. Option B is incorrect as teeth clenching or grinding is not directly related to the observation of frequent swallowing in this scenario. Option C is incorrect because stimulating the gag reflex is not necessary at this point and may be uncomfortable for the child. Option D is incorrect as evaluating a change in voice tone is not relevant to the situation of observing frequent swallowing.

5. What is the recommended analgesia for preparing a school-age child for a lumbar puncture (LP)?

• A. Ondansetron (Zofran) 4 mg / 5 ml PO TID.
• B. Codeine 10 mg PO 30 minutes before the procedure.
• C. A transdermal fentanyl (Duragesic) patch immediately before the procedure.
• D. EMLA (eutectic mixtures of local anesthetics) 2.5 hours before the procedure.

Correct answer: D

Rationale: For a lumbar puncture in a school-age child, EMLA cream should be applied 2.5 hours before the procedure. EMLA is commonly used to numb the skin, reducing pain and discomfort for the child during the procedure. Choices A, B, and C are incorrect because ondansetron is an antiemetic, codeine is an opioid analgesic that may not be suitable for children, and transdermal fentanyl is a strong opioid that is not typically used for local anesthesia in children undergoing lumbar puncture.

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