Nursing Elites

1. The nurse is caring for a 4-year-old child who is hospitalized with pneumonia. The child is receiving IV antibiotics and oxygen therapy. The nurse notes that the child’s respiratory rate is 40 breaths per minute, and the oxygen saturation is 92%. What is the nurse’s priority action?

• A. Increase the child’s oxygen flow rate
• B. Notify the healthcare provider
• C. Encourage the child to take deep breaths
• D. Auscultate the child’s lung sounds

Correct answer: D

Rationale: In this scenario, the child is hospitalized with pneumonia, receiving IV antibiotics and oxygen therapy. With a high respiratory rate and decreased oxygen saturation, auscultating the child’s lung sounds is the priority action. This assessment can provide crucial information about the child’s respiratory status, such as the presence of adventitious sounds or decreased air entry, which can guide further interventions and help in evaluating the effectiveness of the current treatments. Increasing the oxygen flow rate may not address the underlying issue causing the decreased oxygen saturation. Notifying the healthcare provider can be necessary but auscultating lung sounds should be done first to gather more information. Encouraging the child to take deep breaths is important for respiratory function but should not be the immediate priority in this situation.

2. 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.

3. A mother brings her school-aged daughter to the pediatric clinic for evaluation of her anti-epileptic medication regimen. What information should the nurse provide to the mother?

• A. The medication dose will be tapered over a period of 2 weeks when being discontinued
• B. If seizures return, multiple medications will be prescribed for another 2 years
• C. A dose of valproic acid (Depakote) should be available in the event of status epilepticus
• D. Phenytoin (Dilantin) and phenobarbital (Luminal) should be taken for life

Correct answer: A

Rationale: Antiepileptic drugs should not be abruptly stopped as it may lead to seizure recurrence. Tapering the medication over a period of 2 weeks helps to prevent withdrawal effects and minimize the risk of seizures. Choice B is incorrect because starting multiple medications for seizure recurrence is not the first-line approach. Choice C is incorrect because valproic acid is not the first-line medication given in the event of status epilepticus. Choice D is incorrect because antiepileptic medications are usually evaluated over time and adjusted based on the individual's response; it is not always necessary to take them for life.

4. The healthcare provider is caring for a 6-year-old child diagnosed with glomerulonephritis. Which finding should the healthcare provider report promptly to the healthcare provider?

• A. Dark-colored urine
• B. Mild periorbital edema
• C. Blood pressure of 150/95 mm Hg
• D. Urine output of 250 mL in 24 hours

Correct answer: C

Rationale: Hypertension is a serious complication of glomerulonephritis, as it can lead to further renal damage. A blood pressure reading of 150/95 mm Hg is elevated and should be reported promptly to the healthcare provider for immediate management to prevent complications. Dark-colored urine can be a common symptom of glomerulonephritis due to blood in the urine but is not as urgent as managing hypertension. Mild periorbital edema can also be seen in glomerulonephritis but is not as concerning as elevated blood pressure. Urine output of 250 mL in 24 hours indicates oliguria, which is a concern, but addressing hypertension takes priority to prevent further renal damage.

5. A 6 year old who has asthma is demonstrating a prolonged expiratory phase and wheezing and has a 35% of personal best peak expiratory flow rate (PEFR). Based on these findings, what actions should the nurse take first?

• A. Administer a prescribed bronchodilator.
• B. Encourage the child to cough and deep breath.
• C. Report findings to the health care provider.
• D. Determine what triggers precipitated this attack.

Correct answer: A

Rationale: Administering a bronchodilator will help open the airways and improve breathing.

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