Nursing Elites

1. The nurse is caring for a 15-year-old boy who has sustained burn injuries. The nurse observes the burn developing a purplish color with discharge and a foul odor. The nurse suspects which infection?

• A. Burn wound cellulitis.
• B. Invasive burn cellulitis.
• C. Burn impetigo.
• D. Staphylococcal scalded skin syndrome.

Correct answer: B

Rationale: The correct answer is B: Invasive burn cellulitis. Invasive burn cellulitis presents with the burn developing a dark brown, black, or purplish color with discharge and a foul odor. Burn wound cellulitis (choice A) typically involves redness, warmth, and swelling around the burn site. Burn impetigo (choice C) is a superficial infection characterized by honey-colored crusting. Staphylococcal scalded skin syndrome (choice D) is a condition caused by exotoxins from Staphylococcus aureus, leading to widespread skin peeling.

2. The parents of an infant ask the nurse why their baby is scheduled to receive the intramuscular polio vaccine rather than the oral vaccine. What is the nurse’s best response?

• A. The American Academy of Pediatrics recommends the intramuscular vaccine because it is safer.
• B. The consensus is that either can be used, since both produce the same results and are equally safe.
• C. The oral vaccine is more expensive, so the intramuscular vaccine is preferred unless it is contraindicated.
• D. The U.S. Centers for Disease Control and Prevention recommends the intramuscular vaccine unless the infant or a family member is immunocompromised.

Correct answer: A

Rationale: The American Academy of Pediatrics recommends the intramuscular polio vaccine because it has a better safety profile compared to the oral vaccine. Choice B is incorrect because the AAP specifically recommends the intramuscular vaccine over the oral vaccine. Choice C is incorrect as cost is not the primary reason for preferring the intramuscular vaccine. Choice D is incorrect as the recommendation is based on safety rather than the immunocompromised status of the infant or family members.

3. A parent calls the outpatient clinic requesting information about the appropriate dose of acetaminophen for a 16-month-old child who has signs of an upper respiratory tract infection and fever. The directions on the bottle of acetaminophen elixir are 120 mg every 4 hours when needed. At the toddler’s 15-month visit, the health care provider prescribed 150 mg. What is the nurse’s best response to the parent?

• A. “The dose is close enough, and it doesn’t really matter which one is given.”
• B. “From your description, the medications are not necessary. They should be avoided at this age.”
• C. “It is appropriate to use dosages based on age. Children typically have weights consistent for their age groups.”
• D. “The prescribed dose of the drug was based on weight, and this is a more accurate way of determining a therapeutic dose.”

Correct answer: D

Rationale: The most accurate way to determine a therapeutic dose for children is based on their weight rather than age. Weight-based dosing helps ensure that the child receives the appropriate amount of medication for their body size, which is crucial for safety and effectiveness. Age-based dosing can lead to underdosing or overdosing, as children of the same age can have significantly different weights. Choice A is incorrect because even small variations in dosages can have significant effects on a child's health. Choice B is incorrect as acetaminophen can be appropriate when used correctly for fever management in children. Choice C is incorrect as children's weights can vary greatly within the same age group, making weight-based dosing more precise and individualized.

4. An infant with hypertrophic pyloric stenosis (HPS) is admitted to the pediatric unit. What does the nurse expect to find when palpating the infant’s abdomen?

• A. A distended colon
• B. Marked tenderness around the umbilicus
• C. An olive-sized mass in the right upper quadrant
• D. Rhythmic peristaltic waves in the lower abdomen

Correct answer: C

Rationale: When palpating the abdomen of an infant with hypertrophic pyloric stenosis (HPS), the nurse would expect to feel an olive-sized mass in the right upper quadrant. This finding is characteristic of HPS, where the hypertrophied pyloric muscle forms a palpable mass in the abdomen. Choices A, B, and D are incorrect. A distended colon is not a typical finding in HPS, marked tenderness around the umbilicus is not specific to this condition, and rhythmic peristaltic waves in the lower abdomen are not associated with HPS.

5. A nurse plans to talk to the parents of a toddler about toilet training. What should the nurse explain is the most important factor in the process of toilet training?

• A. Parents' attitude about it
• B. Child's desire to remain dry
• C. Child's ability to sit still on the toilet
• D. Parents' willingness to work at the toilet training

Correct answer: D

Rationale: The most crucial factor in the process of toilet training is the parents' willingness to consistently engage and work with their child. While parents' attitude and the child's desire to remain dry can influence the process, the key to successful toilet training lies in the parents' commitment and effort. The child's ability to sit still on the toilet is important but not as critical as the parents' active involvement and support in guiding and encouraging the child through the training process.

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