Nursing Elites

1. The nurse is caring for a 14-year-old adolescent who was admitted to the hospital after a suicide attempt. The adolescent’s mood appears stable, and the healthcare provider has recommended discharge. What is the nurse’s priority action?

• A. Ensure that a safety plan is in place before discharge
• B. Provide education about medication adherence
• C. Encourage the adolescent to participate in group therapy
• D. Schedule a follow-up appointment with a mental health professional

Correct answer: A

Rationale: The priority action for the nurse is to ensure that a safety plan is in place before discharge. A safety plan is essential to assist the adolescent in managing future crises and decreasing the likelihood of another suicide attempt. It provides guidance on coping strategies and resources to help the adolescent stay safe in times of distress.

2. What intervention should the nurse implement first for a male toddler brought to the emergency center approximately three hours after swallowing tablets from his grandmother’s bottle of digoxin (Lanoxin)?

• A. Administer activated charcoal orally
• B. Prepare gastric lavage
• C. Obtain a 12-lead electrocardiogram
• D. Give IV digoxin immune fab (Digibind)

Correct answer: D

Rationale: In cases of digoxin toxicity, IV digoxin immune fab (Digibind) is the antidote and should be administered first to counteract the effects of digoxin poisoning. This intervention is crucial in managing digoxin overdose and should be initiated promptly to improve patient outcomes. Activated charcoal and gastric lavage are not effective in treating digoxin poisoning and may not be beneficial at this stage. While obtaining an electrocardiogram is important to assess cardiac function, administering the antidote should take precedence to address the immediate life-threatening effects of digoxin toxicity.

3. A 12-year-old child with type 1 diabetes is under the nurse's care. The child’s parent asks how to prevent hypoglycemia during physical activity. What is the nurse’s best response?

• A. Give your child extra insulin before exercise
• B. Make sure your child eats a snack before exercise
• C. Limit your child’s physical activity to avoid hypoglycemia
• D. Monitor your child’s blood glucose levels after exercise

Correct answer: B

Rationale: The most effective way to prevent hypoglycemia during physical activity in a child with type 1 diabetes is to ensure they eat a snack before exercising. Eating a snack before exercise helps maintain blood glucose levels by providing additional glucose for energy during physical activity, reducing the risk of hypoglycemia. Giving extra insulin before exercise (Choice A) can increase the risk of hypoglycemia as it lowers blood glucose levels further. Limiting physical activity (Choice C) is not recommended as exercise is important for overall health. Monitoring blood glucose levels after exercise (Choice D) is essential but does not directly prevent hypoglycemia during physical activity.

4. The nurse is conducting an admission assessment of an 11-month-old infant with CHF who is scheduled for repair of restenosis of coarctation of the aorta that was repaired 4 days after birth. Findings include blood pressure higher in the arms than the lower extremities, pounding brachial pulses, and slightly palpable femoral pulses. What pathophysiologic mechanisms support these findings?

• A. The aortic semilunar valve obstructs blood flow into the systemic circulation
• B. The lumen of the aorta reduces the volume of the blood flow to the lower extremities
• C. The pulmonic valve prevents adequate blood volume into the pulmonary circulation
• D. An opening in the atrial septum causes a murmur due to a turbulent left to right shunt

Correct answer: B

Rationale: The findings are consistent with coarctation of the aorta, where narrowing of the aorta leads to decreased blood flow to the lower extremities. This results in higher blood pressure in the arms compared to the lower extremities, pounding brachial pulses, and slightly palpable femoral pulses. Choices A, C, and D are incorrect because they do not align with the pathophysiological mechanisms of coarctation of the aorta, which specifically involves narrowing of the aortic lumen reducing blood flow to the lower extremities.

5. The healthcare provider is developing the plan of care for a hospitalized child with von Willebrand disease. What priority nursing intervention should be included in this child's plan of care?

• A. Reduce exposure to infection.
• B. Eliminate contact with cold objects.
• C. Guard against bleeding injuries.
• D. Reduce contact with other children.

Correct answer: C

Rationale: Children with von Willebrand disease have a deficiency in a clotting protein, putting them at risk of bleeding episodes. The priority nursing intervention for a child with von Willebrand disease is to guard against bleeding injuries to prevent excessive bleeding or hemorrhage. Choices A, B, and D are not the priority interventions for von Willebrand disease. While reducing exposure to infection is important for any hospitalized child, it is not the priority for von Willebrand disease. Eliminating contact with cold objects is more relevant for conditions like Raynaud's disease. Reducing contact with other children is not a specific priority related to managing von Willebrand disease.

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