Nursing Elites

1. What is the appropriate technique for performing two-rescuer CPR on a 4-year-old child?

• A. 15 compressions to 2 ventilations, compressing the sternum with your thumbs, and delivering at least 100 compressions per minute.
• B. 30 compressions to 2 ventilations, compressing the chest one third the depth of the chest, and delivering each breath over 1 second.
• C. 15 compressions to 2 ventilations, compressing the sternum with the heel of your hand, and ventilating until visible chest rise occurs.
• D. 30 compressions to 2 ventilations, compressing the sternum with the heel of both hands, and delivering each breath over 1 to 2 seconds.

Correct answer: C

Rationale: When performing two-rescuer CPR on a 4-year-old child, the appropriate technique involves 15 compressions to 2 ventilations. Compressions should be done by pressing the child's sternum with the heel of your hand. Ventilations should be given until visible chest rise occurs. This technique ensures effective CPR delivery for a child in need of resuscitation.

2. A 7-year-old child has an altered mental status, high fever, and a generalized rash. You perform your assessment and administer supplemental oxygen. En route to the hospital, you should be MOST alert for:

• A. hypotension.
• B. combativeness.
• C. convulsions.
• D. respiratory distress.

Correct answer: C

Rationale: In a 7-year-old child with altered mental status, high fever, and a generalized rash, the most critical concern is the potential for convulsions. These symptoms could indicate a serious underlying condition, such as a febrile seizure or another type of seizure activity. Monitoring for convulsions is crucial during transport to ensure prompt intervention if they occur, as seizures can lead to additional complications and require immediate management.

3. The parents of a child hospitalized with asthma who is recovering and is being prepared for discharge are receiving home care instructions from the nurse. Which statement by a parent indicates a need for further instruction?

• A. Coughing spells may be triggered by dust or smoke
• B. Vomiting may occur when our child has coughing episodes
• C. We need to encourage our child to drink fluids
• D. We need to maintain droplet precautions and a quiet environment for at least 2 weeks

Correct answer: D

Rationale: The statement 'We need to maintain droplet precautions and a quiet environment for at least 2 weeks' indicates a need for further instruction. Asthma management does not typically require maintaining droplet precautions. The focus should be on environmental control, medication adherence, and monitoring symptoms rather than droplet precautions, which are more relevant for contagious respiratory infections.

4. A 4-year-old boy with a tracheostomy tube is experiencing respiratory distress. He has intercostal retractions, a heart rate of 80 beats/min, and an oxygen saturation of 85%. During his attempts to breathe, a gurgling sound is heard in the tracheostomy tube. You should:

• A. Ventilate through the tracheostomy tube.
• B. Place an oxygen mask over the tracheostomy tube.
• C. Remove the tracheostomy tube and clean it.
• D. Carefully suction the tracheostomy tube.

Correct answer: D

Rationale: In this scenario, the 4-year-old boy with a tracheostomy tube is showing signs of respiratory distress, including intercostal retractions, a low heart rate, and decreased oxygen saturation. The gurgling sound indicates a possible airway obstruction. Correctly, the immediate action should be to carefully suction the tracheostomy tube. Suctioning can help clear any secretions or obstructions, thus improving the child's ability to breathe effectively. Ventilating through the tube, placing an oxygen mask over it, or removing and cleaning the tube would not address the potential obstruction and could worsen the respiratory distress.

5. What is the proper depth of chest compressions for a 9-month-old infant?

• A. 1/3 the diameter of the chest or about 1 1/2 inches.
• B. 1/4 the diameter of the chest or about 1 inch.
• C. 1/2 the diameter of the chest or about 2 inches.
• D. 1/3 the diameter of the chest or about 3/4 inch.

Correct answer: A

Rationale: When performing chest compressions on a 9-month-old infant, the proper depth is 1/3 the diameter of the chest, which equates to approximately 1 1/2 inches. This depth is crucial for effective cardiopulmonary resuscitation (CPR) in infants. Choice B, which suggests 1/4 the diameter of the chest or about 1 inch, is incorrect as it does not provide the recommended depth for infants. Choice C, stating 1/2 the diameter of the chest or about 2 inches, is too deep and may cause harm to the infant. Choice D, mentioning 1/3 the diameter of the chest or about 3/4 inch, is also incorrect as it underestimates the required depth for effective chest compressions on a 9-month-old infant.

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