Nursing Elites

1. The mother of an 11-year-old boy with juvenile arthritis tells the nurse, 'I really don’t want my son to become dependent on pain medication, so I only allow him to take it when he is really hurting.' Which information is most important for the nurse to provide this mother?

• A. Encouraging the child to rest when he experiences pain
• B. Encouraging quiet activities like watching television as a pain distractor
• C. Suggesting the use of hot baths as an alternative to pain medication
• D. Explaining that giving pain medication around the clock helps control the pain

Correct answer: D

Rationale: The nurse should educate the mother that giving pain medication around the clock helps maintain a consistent level of pain control, preventing severe pain episodes and improving the child's quality of life. It is essential to manage pain proactively rather than waiting for the child to be in severe pain before administering medication. Choices A, B, and C do not address the importance of proactive pain management and maintaining a consistent level of pain control. Encouraging rest, quiet activities, or hot baths as distractions or alternatives may not provide adequate pain relief for the child with juvenile arthritis, and they do not address the underlying issue of effective pain management.

2. During a well-baby check of a 7-month-old infant, the practical nurse notes an absence of babbling. Which focused assessment should the PN implement?

• A. Visual function.
• B. Auditory function.
• C. Cognitive function.
• D. Social development.

Correct answer: B

Rationale: The absence of babbling in a 7-month-old infant is a concerning auditory development milestone. Babbling is an early stage of language development that involves making various sounds. A lack of babbling could indicate a hearing impairment or other auditory issues. Therefore, the practical nurse should focus on assessing the infant's auditory function to determine if further evaluation or intervention is necessary. Choices A, C, and D are incorrect because the absence of babbling specifically points towards a potential issue related to auditory function rather than visual, cognitive, or social development.

3. A toddler with a chronic illness that requires frequent hospitalization is likely to experience which psychosocial developmental challenge?

• A. Fixation with feelings of inadequacy
• B. Interference with the development of autonomy
• C. Distortion of differentiation of self from parent
• D. Delayed language, fine-motor, and self-care skills

Correct answer: B

Rationale: Toddlers with chronic illnesses requiring frequent hospitalization may experience interference with the development of autonomy. This is because the need for constant medical care can restrict their independence and ability to explore and make choices, which are essential aspects of achieving autonomy according to Erikson's stages of psychosocial development. Choices A, C, and D are incorrect. Fixation with feelings of inadequacy (Choice A) is more commonly associated with Erikson's stage of industry vs. inferiority in middle childhood. Distortion of differentiation of self from parent (Choice C) is related to the separation-individuation phase of Mahler's theory of object relations, typically occurring in infancy. Delayed language, fine-motor, and self-care skills (Choice D) may be impacted by chronic illness but are not the primary psychosocial developmental challenge faced by toddlers in this context.

4. A 7-year-old child with type 1 diabetes is brought to the emergency department with abdominal pain, nausea, and vomiting. The nurse notes that the child's blood glucose level is 350 mg/dL. What should the nurse do first?

• A. Administer IV fluids as prescribed
• B. Administer insulin as prescribed
• C. Monitor the child's urine output
• D. Check the child's urine for ketones

Correct answer: A

Rationale: In a child with type 1 diabetes presenting with abdominal pain, nausea, vomiting, and a high blood glucose level, the priority is to administer IV fluids to correct dehydration and electrolyte imbalances, which are crucial in managing diabetic ketoacidosis. Administering insulin without addressing fluid deficits can lead to further complications. While monitoring urine output and checking for ketones are important steps in the care of a child with diabetes, the immediate focus should be on correcting dehydration and electrolyte imbalances through IV fluid administration to stabilize the child's condition.

5. A 6 year old who has asthma is demonstrating a prolonged expiratory phase and wheezing and has a 35% of personal best peak expiratory flow rate (PEFR). Based on these findings, what actions should the nurse take first?

• A. Administer a prescribed bronchodilator.
• B. Encourage the child to cough and deep breath.
• C. Report findings to the health care provider.
• D. Determine what triggers precipitated this attack.

Correct answer: A

Rationale: Administering a bronchodilator will help open the airways and improve breathing.

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