Nursing Elites

1. The nurse is assessing a 4-year-old child who is brought to the clinic for a routine checkup. The child’s parent reports that the child has been more irritable and less active over the past week. The nurse notes a petechial rash on the child’s trunk and extremities. What should the nurse do first?

• A. Ask the parent about recent exposure to contagious diseases
• B. Review the child’s immunization record
• C. Measure the child’s temperature
• D. Notify the healthcare provider immediately

Correct answer: D

Rationale: In this scenario, the child's presentation with irritability, decreased activity, and a petechial rash raises concern for a serious condition like meningitis. Petechial rash can be indicative of meningitis or other critical illnesses. Therefore, the nurse's priority should be to notify the healthcare provider immediately to ensure prompt evaluation and appropriate management. Asking about recent exposure to contagious diseases may be relevant later but is not the most urgent action. Reviewing the child's immunization record and measuring the temperature can provide valuable information but should not take precedence over the need to address the potential serious condition indicated by the petechial rash.

2. A 10-year-old girl who has had type 1 diabetes mellitus (DM) for the past two years tells the nurse that she would like to use a pump instead of insulin injections to manage her diabetes. Which assessment of the girl is most important for the nurse to obtain?

• A. Understanding of the quality control process used to troubleshoot the pump
• B. Interpretation of fingerstick glucose levels that influence diet selections
• C. Knowledge of her glycosylated hemoglobin A1c levels for the past year
• D. Ability to perform the pump for basal insulin with mealtime boluses

Correct answer: A

Rationale: In a patient transitioning to an insulin pump, understanding the quality control process to troubleshoot the pump is crucial for ensuring proper and safe management of diabetes. This knowledge enables the individual to identify and address any issues that may arise with the pump, helping maintain optimal glycemic control and prevent complications. Choices B, C, and D, although important in diabetes management, are not as critical as ensuring the correct understanding of troubleshooting the pump, which directly impacts the girl's ability to effectively use the pump for insulin delivery.

3. The practical nurse is caring for a child who has just returned from surgery for an appendectomy. Which intervention should the nurse implement?

• A. Encourage early ambulation.
• B. Apply warm compresses to the incision site.
• C. Monitor for signs of infection at the surgical site.
• D. Provide a high-fiber diet immediately post-op.

Correct answer: C

Rationale: Monitoring for signs of infection at the surgical site is crucial after an appendectomy as it helps in early detection and treatment of any potential complications. This intervention is essential for ensuring the child's proper healing and recovery post-surgery. Encouraging early ambulation is generally beneficial post-operatively but may not be the priority immediately after an appendectomy. Applying warm compresses to the incision site may not be indicated as it can increase the risk of infection. Providing a high-fiber diet immediately post-op is not recommended as the digestive system needs time to recover from surgery.

4. A 9-year-old child is brought to the clinic with a fever, rash, and swollen joints. The nurse notes that the child had a sore throat two weeks ago that was not treated. What condition should the nurse suspect?

• A. Scarlet fever
• B. Rheumatic fever
• C. Kawasaki disease
• D. Juvenile rheumatoid arthritis

Correct answer: B

Rationale: In this scenario, the child's symptoms of fever, rash, and swollen joints following an untreated sore throat two weeks ago are indicative of rheumatic fever. Rheumatic fever can develop as a complication of untreated streptococcal infections, leading to systemic inflammation and affecting various organs, including the joints. This condition manifests with symptoms such as fever, rash, and swollen joints, aligning with the child's presentation in this case. Scarlet fever typically presents with a sandpapery rash and strawberry tongue but does not involve joint inflammation. Kawasaki disease presents with fever, rash, and mucous membrane changes but does not typically involve joint swelling. Juvenile rheumatoid arthritis can cause joint swelling but is not directly linked to a recent untreated sore throat.

5. When developing a behavior modification program for an extremely aggressive 10-year-old boy, what should the nurse do first?

• A. Identify what activities, foods, and toys the child enjoys
• B. Assess the child's previous reactions to punishment
• C. Offer the child positive feedback
• D. Involve other children on the unit in describing the token system

Correct answer: A

Rationale: The first step in developing a behavior modification program for an extremely aggressive 10-year-old boy is to identify what activities, foods, and toys the child enjoys. Understanding the child's motivations is crucial in creating an effective behavior modification plan tailored to his interests and preferences, which can help in positively reinforcing desired behaviors.

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