Nursing Elites

1. The nurse is caring for a 15-year-old adolescent who is admitted with a diagnosis of bulimia nervosa. The adolescent’s vital signs are stable, but the nurse notes that the client has dry skin and appears thin. What is the nurse’s priority action?

• A. Initiate a structured eating plan for the client
• B. Establish a therapeutic relationship with the client
• C. Monitor the client’s electrolyte levels
• D. Provide education on healthy eating habits

Correct answer: C

Rationale: In clients with bulimia nervosa, electrolyte imbalances are common due to purging behaviors and can lead to severe complications. Monitoring electrolyte levels is essential to detect and manage any imbalances promptly, as they can be life-threatening.

2. When reinforcing information about the use of corticosteroids in treating asthma in children, which statement indicates that the parent understands the teaching?

• A. My child should take the medication only when experiencing symptoms.
• B. I will rinse my child's mouth after each use of the inhaler.
• C. I should discontinue the medication if my child seems better.
• D. Corticosteroids are used for quick relief during an asthma attack.

Correct answer: B

Rationale: Rinsing the mouth after using corticosteroid inhalers is crucial as it helps prevent oral thrush, a common side effect associated with these medications. This practice reduces the risk of developing fungal infections in the mouth and throat, maintaining optimal oral health during asthma treatment.

3. When caring for a child with Kawasaki disease, which symptom is the most significant for making this diagnosis?

• A. Desquamation of the palms and soles.
• B. Cervical lymphadenopathy.
• C. Erythema of the hands and feet.
• D. Strawberry tongue.

Correct answer: C

Rationale: Erythema of the hands and feet is a key diagnostic criterion for Kawasaki disease. This, along with other symptoms like fever and strawberry tongue, helps in making the diagnosis. While desquamation of the palms and soles, cervical lymphadenopathy, and strawberry tongue are associated with Kawasaki disease, the presence of erythema of the hands and feet is particularly significant in diagnosing this condition.

4. A mother brings her 2-year-old son to the clinic because he has been crying and pulling on his earlobe for the past 12 hours. The child’s oral temperature is 101.2°F. Which intervention should the nurse implement?

• A. Ask the mother if the child has had a runny nose
• B. Cleanse purulent exudate from the affected ear canal
• C. Apply a topical antibiotic to the periauricle area
• D. Provide parent education to prevent recurrence

Correct answer: A

Rationale: In a child with ear pain and fever, asking about a runny nose is important to assess if the ear pain is associated with a respiratory infection, such as otitis media. This information can guide further assessment and treatment decisions. Choice B is incorrect because cleansing purulent exudate should be done by a healthcare provider, not the nurse. Choice C is incorrect as topical antibiotics should only be applied under healthcare provider's orders. Choice D is not the priority at this moment, as the immediate concern is assessing the association between the ear pain and a possible respiratory infection.

5. A school-age child with a history of type 1 diabetes mellitus is brought to the emergency department with confusion and rapid breathing. The practical nurse (PN) suspects diabetic ketoacidosis (DKA). Which initial intervention should the PN anticipate?

• A. Administer subcutaneous insulin.
• B. Give oral glucose tablets.
• C. Start intravenous fluids.
• D. Administer oxygen therapy.

Correct answer: C

Rationale: Intravenous fluids are typically the initial intervention in diabetic ketoacidosis (DKA) to treat dehydration and stabilize the patient's condition. The fluid replacement helps correct electrolyte imbalances and improve perfusion, which are crucial in managing DKA. Insulin therapy follows after fluid resuscitation to address the underlying cause of DKA, which is the lack of insulin leading to increased ketone production. Administering subcutaneous insulin (Choice A) would be premature without first addressing the dehydration and electrolyte imbalances. Giving oral glucose tablets (Choice B) is contraindicated in DKA as the patient already has high blood glucose levels. Administering oxygen therapy (Choice D) may be necessary based on the patient's condition, but addressing dehydration with intravenous fluids is the priority intervention in DKA.

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