Nursing Elites

1. The caregiver is caring for a 10-year-old child with a history of frequent ear infections. The parents are concerned about their child’s hearing and speech development. What is the caregiver’s best response?

• A. Let’s schedule a hearing test and refer to a speech therapist if needed
• B. Most children outgrow ear infections and speech delays
• C. There is no need to worry unless the infections persist into adolescence
• D. Your child’s hearing and speech should be normal by now

Correct answer: A

Rationale: The appropriate response for the caregiver is to address the parents' concerns by suggesting scheduling a hearing test and potentially referring the child to a speech therapist if necessary. This proactive approach can help evaluate and support the child's hearing and speech development effectively. Choice B is incorrect as assuming that most children outgrow ear infections and speech delays may overlook potential issues that need intervention. Choice C is wrong because waiting until adolescence to address concerns may lead to missed opportunities for early intervention. Choice D is incorrect as it dismisses the parents' valid concerns without offering a solution or further evaluation.

2. The nurse is assessing a 4-month-old infant who has just received routine immunizations. The mother reports that the baby has been fussy and has a low-grade fever since the immunizations. What is the best response by the nurse?

• A. These are common side effects and should resolve within a few days
• B. Your baby may be having an allergic reaction to the immunizations
• C. You should bring your baby to the clinic immediately for evaluation
• D. You should give your baby aspirin to help with the fever

Correct answer: A

Rationale: The correct response by the nurse is to reassure the mother that fussiness and low-grade fever are common side effects of immunizations in infants and should resolve within a few days. It is essential to educate the mother about these expected reactions to alleviate her concerns. Choice B is incorrect because allergic reactions to immunizations usually present with more severe symptoms such as difficulty breathing or swelling. Choice C is not warranted unless there are concerning symptoms present. Choice D is inappropriate as aspirin is contraindicated in infants due to the risk of Reye's syndrome.

3. A 6-month-old female is scheduled to receive diphtheria, tetanus toxoid, and acellular pertussis vaccine (DTaP) and IPV (inactivated poliovirus vaccine) immunizations. She is recovering from a cold but is otherwise healthy and afebrile. Her 5-year-old sister is receiving chemotherapy. Which considerations should the nurse make for this situation?

• A. DTaP and IPV can be safely given to the infant at the scheduled time.
• B. DTaP and IPV are contraindicated because the infant has a cold.
• C. IPV is contraindicated because her sister is immunocompromised.
• D. DTaP is contraindicated because her sister is immunocompromised.

Correct answer: A

Rationale: DTaP and IPV can be safely administered to a child with a mild illness like a cold, even if there is an immunocompromised family member, as these vaccines do not contain live viruses. It is important to ensure that the child is otherwise healthy and afebrile before administering the vaccines. The presence of a cold is not a contraindication for receiving DTaP and IPV vaccines. Choice A is correct because the infant can receive both vaccines as scheduled. Choice B is incorrect as having a cold does not contraindicate DTaP and IPV administration. Choice C is incorrect because IPV is not contraindicated due to the sister's immunocompromised status. Choice D is incorrect as both DTaP and IPV can be given in this scenario.

4. What is the priority action for a 2-year-old child with croup presenting with a barking cough and stridor?

• A. Administer a corticosteroid
• B. Obtain a throat culture
• C. Administer nebulized epinephrine
• D. Place the child in an upright position

Correct answer: C

Rationale: The priority action for a 2-year-old child with croup and stridor is to administer nebulized epinephrine. Nebulized epinephrine helps reduce airway swelling, alleviate symptoms, and improve breathing by causing vasoconstriction and reducing upper airway edema. Administering a corticosteroid may be done but is not the priority in this scenario. Obtaining a throat culture is not necessary for the immediate management of croup. Placing the child in an upright position can aid in breathing but is not the priority action when the child is presenting with stridor.

5. When assessing the breath sounds of an 18-month-old child who is crying, what action should the healthcare professional take?

• A. Document that the assessment is not available because the child is crying.
• B. Ask the caregiver to quiet the child so breath sounds can be auscultated.
• C. Allow the child to play with a stethoscope to distract them during auscultation.
• D. Auscultate and document breath sounds, noting that the child was crying at the time.

Correct answer: C

Rationale: Allowing the child to play with a stethoscope can help distract them, making it easier to auscultate breath sounds. This approach can create a more cooperative and engaging environment for the child, facilitating a more accurate assessment of their breath sounds. Choice A is incorrect because it does not address the need for an assessment. Choice B is not ideal as it puts pressure on the caregiver and may not be effective in calming the child. Choice D is not the best option as it does not actively involve the child in the assessment process and may not provide an accurate representation of their breath sounds.

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