Nursing Elites

1. Justine is admitted to the pediatric unit due to the occurrence of diabetic ketoacidosis signaling a new diagnosis of diabetes. The diabetes team explores the cause of the episode and takes steps to prevent a recurrence. Diabetic ketoacidosis (DKA) results from an excessive accumulation of which of the following?

• A. Sodium bicarbonate from renal compensation
• B. Potassium from cell death
• C. Glucose from carbohydrate metabolism
• D. Ketone bodies from fat metabolism

Correct answer: D

Rationale: Diabetic ketoacidosis (DKA) results from the excessive accumulation of ketone bodies from fat metabolism. During DKA, there is a lack of insulin leading to the breakdown of fat stores into fatty acids and their subsequent conversion into ketone bodies. These ketone bodies accumulate in the blood, leading to metabolic acidosis and the characteristic symptoms of DKA.

2. Which behavior is most indicative that a 2-year-old is experiencing the initial phase of separation anxiety because his parents cannot stay all day at the hospital with him?

• A. He withdraws from the nursing staff.
• B. He cries when his parents leave.
• C. He lies quietly in bed.
• D. He cries when his parents arrive.

Correct answer: B

Rationale: The most indicative behavior of a 2-year-old experiencing the initial phase of separation anxiety due to parents not staying all day at the hospital is crying when his parents leave. This behavior is a common manifestation of separation anxiety in children, as they struggle with the absence of their primary attachment figures. Choices A, C, and D are less indicative because withdrawing from the nursing staff, lying quietly in bed, or crying when parents arrive do not specifically demonstrate the distress caused by separation from parents, which is the hallmark of separation anxiety in children.

3. During your assessment of a woman in labor, you see the baby's arm protruding from the vagina. The mother tells you that she needs to push. You should:

• A. gently push the protruding arm back into the vagina.
• B. encourage the mother to push and give her high-flow oxygen.
• C. insert your gloved fingers into the vagina and try to turn the baby.
• D. cover the arm with a sterile towel and transport immediately.

Correct answer: D

Rationale: When encountering a protruding limb during delivery, it is crucial to recognize this as an emergency situation. The correct action is to cover the limb with a sterile towel to prevent injury and transport the mother immediately to a medical facility. Attempting to push the limb back into the vagina or trying to manipulate the baby's position can be harmful and delay necessary medical intervention. Encouraging the mother to push and providing high-flow oxygen is not appropriate in this scenario as immediate transport is essential to ensure the safety of both the mother and the baby.

4. A 3-year-old female has had severe diarrhea and vomiting for 4 days. She is now unresponsive with rapid, shallow respirations and thready radial pulses. Her heart rate is 160 beats/min, and her oxygen saturation is 88%. You should:

• A. Ventilate her with a bag-valve mask.
• B. Start chest compressions.
• C. Administer high-flow oxygen via a non-rebreathing mask.
• D. Place her in the recovery position.

Correct answer: A

Rationale: In a pediatric patient presenting with unresponsiveness, rapid, shallow respirations, thready pulses, high heart rate, and low oxygen saturation, the priority is to ensure adequate oxygenation. Ventilating the child with a bag-valve mask is crucial in this scenario to support her breathing and improve oxygenation, as indicated by her low oxygen saturation and respiratory distress. Starting chest compressions is not indicated as the child has a pulse. Administering high-flow oxygen via a non-rebreathing mask may not be as effective as providing positive pressure ventilation with a bag-valve mask in this situation. Placing her in the recovery position is not appropriate when the child is unresponsive and in respiratory distress.

5. Where is the most appropriate location to perform a procedure on a preschooler?

• A. Perform the procedure in the child's hospital bed.
• B. Perform the procedure in the treatment room.
• C. Allow the child to decide when the procedure will be performed.
• D. Ask the parents to help restrain the child so the procedure can be performed.

Correct answer: B

Rationale: When performing a procedure on a preschooler, it is most appropriate to do so in the treatment room. This setting is specifically designed to provide a suitable environment with necessary equipment and resources to ensure the procedure is carried out safely and efficiently. It helps minimize distractions and provides a controlled environment for healthcare providers to focus on the child's needs. Choices A, C, and D are incorrect because performing the procedure in the child's hospital bed may lack the necessary resources and equipment, allowing the child to decide when the procedure will be performed may not be feasible due to medical necessity and urgency, and asking parents to help restrain the child is not ideal as it may not provide a professional and controlled setting for the procedure.

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