Nursing Elites

1. The healthcare provider is providing postoperative care to a 4-year-old child who underwent tonsillectomy. The provider notices that the child is frequently swallowing. What should the provider do first?

• A. Check the child’s throat for signs of bleeding
• B. Offer the child ice chips to soothe the throat
• C. Elevate the head of the child’s bed
• D. Administer prescribed pain medication

Correct answer: A

Rationale: Frequent swallowing after tonsillectomy may indicate bleeding, which requires immediate assessment and intervention. Checking the child’s throat for signs of bleeding is the priority to ensure timely identification and management of any potential bleeding complications.

2. What action should the nurse implement after the infusion is complete for a 16-year-old with acute myelocytic leukemia receiving chemotherapy via an implanted medication port at the outpatient oncology clinic?

• A. Administer Zofran
• B. Obtain blood samples for RBCs, WBCs, and platelets
• C. Flush the mediport with saline and heparin solution
• D. Initiate an infusion of normal saline

Correct answer: C

Rationale: After completing the chemotherapy infusion via the implanted medication port, the nurse should flush the mediport with saline and heparin solution. This action helps prevent clot formation in the port, ensuring its patency for future use and reducing the risk of complications associated with catheter occlusion. Administering Zofran (Choice A) is used for managing chemotherapy-induced nausea and vomiting, not for post-infusion care. Obtaining blood samples for RBCs, WBCs, and platelets (Choice B) is important for monitoring the patient's blood count but is not the immediate post-infusion priority. Initiating an infusion of normal saline (Choice D) is not necessary after completing the chemotherapy infusion.

3. The nurse is caring for a 2-year-old child who was admitted for dehydration due to gastroenteritis. The child is now receiving IV fluids and appears more alert. What is the best indicator that the child’s condition is improving?

• A. The child is more alert and playful
• B. The child’s urine output has increased
• C. The child’s vital signs are stable
• D. The child is tolerating small amounts of oral fluids

Correct answer: B

Rationale: Increased urine output is a reliable indicator that hydration status is improving. While alertness and playfulness are positive signs, increased urine output directly reflects improved hydration. Stable vital signs are important but may not directly indicate hydration status. Tolerating small amounts of oral fluids is a good sign but may not be as direct an indicator as increased urine output.

4. While teaching a parenting class to new parents, the nurse describes the needs of infants and toddlers regarding discipline and limit setting. What is the most important reason for implementing such parenting behaviors?

• A. Children need help in developing social skills.
• B. This age group fears loss of self-control.
• C. They provide the child with a sense of security.
• D. Children must learn to deal with authority.

Correct answer: C

Rationale: Implementing discipline and limit setting for infants and toddlers is primarily important as it provides them with a sense of security. This sense of security is crucial for their emotional and psychological development, helping them feel safe and supported as they explore the world around them. Choice A is incorrect because while developing social skills is important, the primary reason for discipline and limit setting in this context is to provide security. Choice B is incorrect as it does not address the main reason for implementing discipline and limit setting. Choice D is incorrect as the primary focus is not about dealing with authority at this early stage of development.

5. While assessing the vital signs of a 10-year-old who underwent a tonsillectomy this morning, the nurse observes the child swallowing every 2-3 minutes. Which assessment should the nurse implement?

• A. Inspect the posterior oropharynx
• B. Assess for teeth clenching or grinding
• C. Touch the tonsillar pillars to stimulate the gag reflex
• D. Ask the child to speak to evaluate a change in voice tone

Correct answer: A

Rationale: Frequent swallowing post-tonsillectomy may indicate bleeding. Inspecting the posterior oropharynx is essential to assess for any signs of bleeding, such as fresh blood or clots, which may necessitate immediate intervention. Option B is incorrect as teeth clenching or grinding is not directly related to the observation of frequent swallowing in this scenario. Option C is incorrect because stimulating the gag reflex is not necessary at this point and may be uncomfortable for the child. Option D is incorrect as evaluating a change in voice tone is not relevant to the situation of observing frequent swallowing.

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