Nursing Elites

1. The healthcare provider is caring for a 3-year-old child who is hospitalized with dehydration. The child is now receiving IV fluids and has started to produce urine. What is the best indicator that the child’s dehydration is improving?

• A. The child’s urine output has increased
• B. The child’s skin turgor is normal
• C. The child’s weight has increased
• D. The child’s vital signs are stable

Correct answer: A

Rationale: An increase in urine output is a reliable indicator that the child's hydration status is improving. Adequate urine output signifies that the kidneys are functioning properly and that the body is effectively eliminating waste and excess fluids, indicating improved hydration levels. The other options are not as direct indicators of hydration status. Skin turgor and weight changes can be influenced by various factors, and stable vital signs do not specifically reflect hydration status.

2. A 13-year-old client with type 1 diabetes is admitted to the hospital with a blood glucose level of 450 mg/dL. The client is lethargic and has fruity-smelling breath. What is the nurse’s priority action?

• A. Administer insulin as prescribed
• B. Start an IV infusion of normal saline
• C. Check the client’s urine for ketones
• D. Monitor the client’s vital signs

Correct answer: B

Rationale: The correct priority action for the nurse is to start an IV infusion of normal saline. The client's presentation with lethargy, fruity-smelling breath, and high blood glucose level indicates diabetic ketoacidosis (DKA). IV fluids are essential to correct dehydration and help stabilize the client's condition. Checking for ketones in the urine is important, but fluid replacement takes precedence to address the immediate risk of dehydration and electrolyte imbalances. Administering insulin is also a crucial intervention for DKA, but fluid resuscitation should first be initiated.

3. 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
• B. Prepare gastric lavage
• C. Obtain a 12-lead electrocardiogram
• D. Give IV digoxin immune fab (Digibind)

Correct answer: A

Rationale: Administering activated charcoal is the priority intervention as it binds with digoxin, preventing further absorption in the gastrointestinal tract. This helps reduce the amount of digoxin available for systemic circulation and minimizes its toxic effects. Gastric lavage is no longer recommended due to potential complications and lack of evidence of efficacy. Obtaining an electrocardiogram may help assess the effects of digoxin toxicity, but it is not the initial priority. IV digoxin immune fab (Digibind) is used in severe cases of digoxin toxicity but is not the first-line intervention.

4. What advice should be provided by the practical nurse to the mother of a school-age child with acute diarrhea and mild dehydration who is occasionally vomiting despite being given an oral rehydration solution (ORS)?

• A. Continue to give ORS frequently in small amounts.
• B. Alternate between ORS and carbonated beverages.
• C. Take the child to the hospital for intravenous fluids.
• D. Place the child NPO for the next eight to nine hours.

Correct answer: A

Rationale: The practical nurse should advise the mother to continue providing the oral rehydration solution (ORS) frequently in small amounts. It is essential to continue ORS administration to prevent dehydration, even if the child is occasionally vomiting. Small, frequent amounts of ORS help maintain hydration levels in children with acute diarrhea and mild dehydration.

5. When reviewing the dietary guidelines for a child with nephrotic syndrome, which diet should the practical nurse reinforce with the parents?

• A. High protein.
• B. Low sodium.
• C. Low fat.
• D. High carbohydrate.

Correct answer: B

Rationale: The correct diet that the practical nurse should reinforce with the parents of a child with nephrotic syndrome is a low-sodium diet. This diet is crucial for managing fluid retention and reducing the risk of edema, which are common concerns in children with nephrotic syndrome.

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