Nursing Elites

1. The child has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management?

• A. Administer a nonsteroidal anti-inflammatory drug (NSAID) as ordered.
• B. Use guided imagery and therapeutic touch.
• C. Administer meperidine as ordered.
• D. Initiate pain assessment with a standardized pain scale.

Correct answer: D

Rationale: Initiating pain assessment with a standardized pain scale is crucial in managing pain effectively during a sickle cell crisis. This step allows the nurse to objectively evaluate the child's pain level and tailor the pain management plan accordingly. Administering medication without a proper assessment could lead to inappropriate pain management. Using guided imagery and therapeutic touch may be beneficial as adjunct therapies but should not replace the initial pain assessment. Meperidine is not typically the first-line choice for pain management in sickle cell crisis due to its potential for neurotoxic metabolites.

2. What should be included in the teaching plan for parents of an infant diagnosed with phenylketonuria (PKU)?

• A. Mental retardation occurs if PKU is untreated.
• B. Testing for PKU is done immediately after birth.
• C. Treatment for PKU includes lifelong dietary management.
• D. PKU is transmitted by an autosomal recessive gene.

Correct answer: A

Rationale: The correct answer is A: 'Mental retardation occurs if PKU is untreated.' Phenylketonuria (PKU) is a metabolic disorder that, if left untreated with dietary management, can lead to severe mental retardation due to the accumulation of phenylalanine. It is crucial for parents to understand the potential consequences of untreated PKU to emphasize the importance of early and consistent treatment. Choice B is incorrect because testing for PKU is typically done through newborn screening shortly after birth, not immediately. Choice C is incorrect as treatment for PKU primarily involves strict dietary management that restricts phenylalanine intake, not lifelong medications. Choice D is incorrect as PKU is inherited in an autosomal recessive pattern, meaning that both parents must pass on a mutated gene for the disorder to manifest.

3. The healthcare provider notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of

• A. poor appetite
• B. increased potassium intake
• C. reduction of edema
• D. restriction to bed rest

Correct answer: C

Rationale: In acute glomerulonephritis, weight loss is most likely due to the reduction of edema. Edema is a common symptom of glomerulonephritis, which causes fluid retention and swelling in the body. As treatment progresses and the condition improves, the reduction of edema leads to weight loss. Choices A, B, and D are incorrect as they do not directly address the underlying pathophysiology of acute glomerulonephritis and its impact on weight loss.

4. When caring for a child and family who just moved out of a dangerous neighborhood, which of the following approaches is appropriate to the family stress theory?

• A. Determining who the decision maker is
• B. Assessing the child's coping abilities
• C. Finding out how siblings feel
• D. Explaining procedures to siblings

Correct answer: B

Rationale: Assessing the child's coping abilities is appropriate when applying the family stress theory because it helps understand how well the child is managing the stress of the situation. This assessment can provide insights into the child's emotional well-being and resilience, enabling healthcare providers to offer appropriate support. Choices A, C, and D are less relevant in the context of family stress theory. Determining who the decision-maker is may be important but is not directly related to assessing the child's coping abilities. Finding out how siblings feel and explaining procedures to siblings may be valuable aspects of care but are not specifically aligned with the core principles of the family stress theory, which focus on understanding and addressing stress within the family unit.

5. A child has been diagnosed with classic hemophilia. A nurse teaches the child’s parents how to administer the plasma component factor VIII through a venous port. It is to be given 3 times a week. What should the nurse tell them about when to administer this therapy?

• A. Whenever a bleed is suspected
• B. In the morning on scheduled days
• C. At bedtime while the child is lying quietly in bed
• D. On a regular schedule at the parents’ convenience

Correct answer: B

Rationale: Administering factor VIII in the morning on scheduled days ensures that there is a consistent level of the plasma component throughout the day, especially when the child is active. This timing helps to maintain adequate levels of factor VIII to prevent bleeding episodes. Choice A is incorrect because administering factor VIII only when a bleed is suspected would not provide the consistent prophylactic coverage needed for children with hemophilia. Choice C is incorrect as bedtime administration may not be practical for ensuring the plasma component is available during the child's active hours. Choice D is incorrect because administering factor VIII on a regular schedule, rather than at specific times of the day, may not optimize its effectiveness in preventing bleeding episodes.

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