Nursing Elites

1. The nurse is teaching the family of a child with a long-term central venous access device about signs and symptoms of bacteremia. What finding indicates the presence of bacteremia?

• A. Hypertension
• B. Pain at the entry site
• C. Fever and general malaise
• D. Redness and swelling at the entry site

Correct answer: C

Rationale: Fever and general malaise are systemic signs of bacteremia, indicating that the infection may have spread beyond the local entry site. Localized pain, redness, and swelling are signs of a localized infection but do not necessarily indicate bacteremia.

2. Which congenital heart defect causes a "boot-shaped" heart on a chest x-ray?

• A. Tetralogy of Fallot
• B. Coarctation of the aorta
• C. Transposition of the great arteries
• D. Ventricular septal defect

Correct answer: A

Rationale: The correct answer is A: Tetralogy of Fallot. Tetralogy of Fallot, a congenital heart defect with four distinct abnormalities, often presents with a "boot-shaped" heart on chest x-ray due to right ventricular hypertrophy. This characteristic finding is due to the specific combination of defects in this condition. Coarctation of the aorta (choice B), Transposition of the great arteries (choice C), and Ventricular septal defect (choice D) do not typically result in a "boot-shaped" heart on a chest x-ray like Tetralogy of Fallot does.

3. What component should be included in the nutritional management of a child with Crohn's disease?

• A. High fiber
• B. Increased protein
• C. Reduced calories
• D. Herbal supplements

Correct answer: B

Rationale: The correct answer is B: Increased protein. Children with Crohn's disease require a diet high in protein to support growth and tissue repair. High fiber should be avoided as it can exacerbate symptoms of Crohn's disease. Reducing calories can lead to malnutrition, which is detrimental in this condition. Herbal supplements should be used cautiously and only under medical advice as they may interact with medications or worsen symptoms.

4. An intravenous line is needed in a school-age child. What medication is an appropriate analgesic for use with this patient?

• A. TAC (tetracaine, epinephrine [Adrenalin], cocaine) 15 minutes before the procedure.
• B. A transdermal fentanyl (Duragesic) patch at the site of venipuncture.
• C. EMLA (eutectic mixture of local anesthetics) immediately before the procedure.
• D. LMX (4% liposomal lidocaine cream) 30 minutes before the procedure.

Correct answer: D

Rationale: LMX is an effective analgesic agent when applied to the skin 30 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. TAC provides skin anesthesia about 15 minutes after application to nonintact skin, making it more suitable for wound suturing. Transdermal fentanyl patches are designed for continuous pain control, not rapid pain control needed for a procedure like venipuncture. EMLA, for maximum effectiveness, must be applied approximately 60 minutes before the procedure, making it less suitable for immediate pain relief required for intravenous line placement.

5. The nurse determines that a child's intravenous infusion has infiltrated. The infused solution is a vesicant. What is the most appropriate nursing action?

• A. Stop the infusion and apply ice.
• B. End the infusion and notify the practitioner.
• C. Slow the infusion rate and notify the practitioner.
• D. Discontinue the infusion and apply warm compresses.

Correct answer: B

Rationale: If a vesicant solution infiltrates, stopping the infusion immediately and notifying the practitioner is critical to prevent tissue damage. Cold or warm compresses should only be applied following specific medical advice based on the vesicant involved.

Similar Questions