Nursing Elites

1. The nurse is providing care for a pediatric client in the emergency department (ED) with a diagnosis of decreased level of consciousness (LOC) secondary to increased intracranial pressure (ICP). Which healthcare provider order should the nurse question?

• A. Passive range-of-motion exercises to promote hip flexion
• B. Oxygen at 2 L nasal cannula to maintain saturation above 95%
• C. Hourly vital signs and neurologic checks
• D. Elevate head of bed 30 degrees

Correct answer: A

Rationale: In a pediatric client with increased intracranial pressure (ICP) and decreased level of consciousness (LOC), passive range-of-motion exercises to promote hip flexion should be questioned as they can potentially increase intracranial pressure. This action may not be safe for the client's condition. The other options are appropriate interventions for managing a pediatric client with increased ICP and decreased LOC.

2. The healthcare professional is completing the intake and output record for a child admitted for fluid volume deficit. The child has had the following intake and output during the shift: 4 oz of Pedialyte, One-half of an 8-oz cup of clear orange Jell-O, Two graham crackers, 200 mL of D5 1/2 sodium chloride IV. Output: 345 mL of urine, 50 mL of loose stool. How many milliliters should the healthcare professional document as the client's total intake? Give the numerical answer only. Do not include any units of measurement.

• A. 440
• B. 400
• C. 410
• D. 450

Correct answer: A

Rationale: The total intake is 440 mL (4 oz of Pedialyte = 120 mL, half of an 8 oz cup of Jell-O = 120 mL, and 200 mL of IV fluids). The graham crackers are not counted as intake. Therefore, the correct answer is 440. Choice B (400) is incorrect because it does not account for the intake of Jell-O. Choice C (410) is incorrect as it does not include the Pedialyte intake. Choice D (450) is incorrect because it overestimates the total intake by including the graham crackers.

3. What is the priority nursing action when preparing a neonate born with a gastroschisis defect for transport to a pediatric hospital for corrective surgery?

• A. Covering the exposed intestines with sterile moist gauze
• B. Wrapping the newborn warmly in two or three blankets
• C. Providing sterile water feeding to maintain hydration during transport
• D. Allowing the parents of the newborn to see their child prior to transport

Correct answer: A

Rationale: The priority nursing action when preparing a neonate born with a gastroschisis defect for transport is to cover the exposed intestines with sterile moist gauze. This action helps prevent infection and keeps the tissue viable during transportation to the pediatric hospital for corrective surgery.

4. A child is being assessed for Kawasaki disease. Which of the following findings should be expected?

• A. Decreased heart rate
• B. Dry, scaly skin
• C. Fever unresponsive to antipyretics
• D. Nontender cervical lymphadenopathy

Correct answer: C

Rationale: In Kawasaki disease, a child typically presents with a fever that is unresponsive to antipyretics because the disease is characterized by systemic inflammation. The persistent fever is a hallmark feature of the disease and can last for more than five days despite treatment with antipyretics.

5. The caregiver is providing care to a pediatric client diagnosed with inflammatory bowel disease, who is prescribed daily prednisone. Which caregiver statement regarding administration of this drug indicates correct understanding of the teaching provided by the healthcare provider?

• A. I will administer this medication between meals.
• B. I will administer this medication at bedtime.
• C. I will administer this medication one hour before meals.
• D. I will administer this medication with meals.

Correct answer: D

Rationale: The correct answer is D. Prednisone should be administered with meals to reduce gastrointestinal upset. Taking prednisone with food helps to minimize stomach irritation and other gastrointestinal side effects associated with the medication.

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