Nursing Elites

1. The nurse is preparing a presentation on compensated, decompensated, and irreversible shock in children. What clinical manifestations related to decompensated shock should the nurse include? (Select all that apply.)

• A. All below
• B. Oliguria
• C. Confusion
• D. Pale extremities

Correct answer: A

Rationale: Decompensated shock is characterized by signs such as oliguria, confusion, pale extremities, hypotension, and a thready pulse. These indicate that the body is no longer able to maintain adequate circulation to vital organs.

2. Which is a consequence of the physical punishment of children, such as spanking?

• A. The psychological impact is usually minimal.
• B. The child's development of reasoning increases.
• C. Children rarely become accustomed to spanking.
• D. Misbehavior is likely to occur when parents are not present.

Correct answer: D

Rationale: Physical punishment, such as spanking, may result in children misbehaving when parents are not present, as it does not teach appropriate behavior or self-regulation.

3. The nurse is caring for a child with suspected ingestion of some type of poison. What action should the nurse take next after initiating cardiopulmonary resuscitation (CPR)?

• A. Empty the mouth of pills, plants, or other material.
• B. Question the victim and witness.
• C. Place the child in a side-lying position.
• D. Call poison control.

Correct answer: D

Rationale: After ensuring the child's immediate survival needs are met with CPR, contacting poison control is critical to receive specific guidance on how to proceed with treatment. Other actions may be necessary depending on the situation but should follow contacting poison control.

4. Which pediatric condition is most likely to present with a "whooping" sound during coughing?

• A. Croup
• B. Bronchitis
• C. Pertussis
• D. Asthma

Correct answer: C

Rationale: The correct answer is C: Pertussis. Pertussis, also known as whooping cough, is characterized by a "whooping" sound during coughing episodes. This distinctive sound is due to the rapid intake of air after a series of coughs. Choice A, Croup, typically presents with a barking cough and stridor. Choice B, Bronchitis, is characterized by a productive cough with mucus. Choice D, Asthma, usually presents with wheezing and shortness of breath.

5. The nurse is assessing a 3-day-old breastfed newborn who weighed 3400 g (7 pounds, 8 oz) at birth. The infant’s mother is now concerned because the infant weighs 3147 g (6 pounds, 15 oz). The most appropriate nursing intervention is what?

• A. Recommend supplemental feedings of formula.
• B. Explain that this weight loss is within normal limits.
• C. Assess the child further to determine the cause of excessive weight loss.
• D. Encourage the mother to express breast milk for bottle-feeding the infant.

Correct answer: B

Rationale: A neonate normally loses about 10% of the birth weight by age 3 to 4 days. The birth weight is usually regained by the 10th day of life. In this case, the weight loss from 3400 g to 3147 g is within the expected range. Therefore, the most appropriate action is to explain to the mother that this weight loss is within normal limits. Choice A is incorrect because supplemental feedings of formula are not indicated for this expected weight loss in a breastfed newborn. Choice C is incorrect as there is no evidence to suggest excessive weight loss at this point. Choice D is unnecessary at this stage and may not align with the current situation of normal weight loss post-birth.

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