Nursing Elites

1. The nurse is caring for a 10-year-old with Duchenne muscular dystrophy. As part of the plan of care, the nurse focuses on maintaining his cardiopulmonary function. Which intervention would the nurse implement to best promote maximum chest expansion?

• A. Deep-breathing exercises
• B. Upright positioning
• C. Coughing
• D. Chest percussion

Correct answer: B

Rationale: Upright positioning is the optimal intervention to promote maximum chest expansion in a child with Duchenne muscular dystrophy. By placing the child in an upright position, gravity can assist in expanding the chest cavity, facilitating better lung expansion and improving breathing efficiency. Deep-breathing exercises may be beneficial but are not as effective in maximizing chest expansion as upright positioning. Coughing and chest percussion focus more on airway clearance and are not directly aimed at promoting chest expansion.

2. A 4-year-old child is brought to the emergency department with a suspected fracture. What is the priority nursing action?

• A. Immobilize the affected limb
• B. Apply ice to the affected area
• C. Elevate the affected limb
• D. Check the child's neurovascular status

Correct answer: A

Rationale: The priority nursing action when a child with a suspected fracture is brought to the emergency department is to immobilize the affected limb. Immobilization helps prevent further injury until a fracture is confirmed or ruled out. Applying ice or elevating the limb can wait until after immobilization has been achieved. Checking the child's neurovascular status is important but is not the priority action in this situation.

3. What is the priority nursing intervention for a child with a diagnosis of acute lymphoblastic leukemia (ALL) receiving chemotherapy?

• A. Preventing infection
• B. Administering chemotherapy
• C. Providing nutritional support
• D. Monitoring fluid intake

Correct answer: A

Rationale: The priority nursing intervention for a child with acute lymphoblastic leukemia (ALL) receiving chemotherapy is to prevent infection. Chemotherapy compromises the child's immune system, increasing susceptibility to infections. Preventing infection is crucial to avoid potential complications such as sepsis, which can be life-threatening. Administering chemotherapy is essential for treating ALL but preventing infection takes precedence due to the increased risk of infections associated with chemotherapy-induced immunosuppression. Providing nutritional support is important for overall health but preventing infections is more critical in this context. Monitoring fluid intake is significant, but the priority is to prevent infections that can have severe consequences in an immunocompromised child.

4. During a vaccination drive at a well-child clinic, a nurse observes that a recently hired nurse is not wearing gloves. What should the nurse advise the newly hired nurse to do?

• A. Speak with the nurse manager regarding techniques.
• B. Put on gloves because standard precautions are required.
• C. Continue with the immunizations because gloves are not needed.
• D. Evaluate the child’s appearance to determine whether gloves are needed.

Correct answer: B

Rationale: The correct answer is B: "Put on gloves because standard precautions are required." Standard precautions are essential in healthcare settings to prevent the transmission of infections, and wearing gloves is a crucial part of these precautions during immunizations. Choice A is incorrect because speaking with the nurse manager about techniques does not address the immediate need for wearing gloves. Choice C is incorrect because gloves are indeed needed to prevent the spread of infections. Choice D is incorrect as evaluating the child's appearance is not a substitute for wearing gloves which are a basic infection control measure.

5. The parents of a 2-year-old child tell the nurse that they are having difficulty disciplining their child. What is the nurse’s most appropriate response?

• A. “This is a challenging age for your child right now.”
• B. “Could you elaborate on your challenges? I’m not clear on what you mean.”
• C. “It’s important to be consistent with toddlers when they need discipline.”
• D. “I understand your concern. This phase is often referred to as the 'terrible twos'.”

Correct answer: C

Rationale: The most appropriate response for the nurse is to emphasize the importance of consistency in discipline when dealing with toddlers. Toddlers are at a stage where they are exploring boundaries and learning what behaviors are acceptable. By being consistent, parents can help reinforce these boundaries and teach appropriate behaviors effectively. Choices A, B, and D do not provide specific guidance on how to address the discipline issue effectively. While acknowledging the challenges of this age (Choice A) and empathizing with the parents (Choice D) are important, the key point in this scenario is to highlight the significance of consistency in discipline (Choice C).

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