Nursing Elites

1. Why is the infant scheduled to receive the intramuscular polio vaccine instead of the oral vaccine, as asked by the parents?

• A. The American Academy of Pediatrics recommends the intramuscular vaccine because it is safer.
• B. Both vaccines produce the same results and are equally safe, according to consensus.
• C. The intramuscular vaccine is preferred over the oral vaccine due to cost considerations, unless contraindicated.
• D. The U.S. Centers for Disease Control and Prevention recommends the intramuscular vaccine unless the infant or a family member is immunocompromised.

Correct answer: A

Rationale: The American Academy of Pediatrics recommends the intramuscular polio vaccine over the oral vaccine due to its superior safety profile. Intramuscular administration ensures better immunogenicity and protection against poliovirus. Choice B is incorrect as the intramuscular vaccine is preferred for safety reasons. Choice C is incorrect because the recommendation is based on safety, not cost. Choice D is incorrect as the CDC recommendation is not solely based on immunocompromised status but rather on the overall safety and efficacy of the vaccine.

2. A 2-year-old child who was admitted to the hospital for further surgical repair of a clubfoot is standing in the crib, crying. The child refuses to be comforted and calls for the mother. As the nurse approaches the crib to provide morning care, the child screams louder. Knowing that this behavior is typical of the stage of protest, what is the most appropriate nursing intervention?

• A. Use comforting measures while holding the child.
• B. Fill the basin with water and proceed to bathe the child.
• C. Sit by the crib and bathe the child later when the anxiety decreases.
• D. Postpone the bath for a day because a child this upset should not be traumatized further.

Correct answer: C

Rationale: During the stage of protest, children may exhibit distress and cling to familiar figures, resisting interactions with others. The most appropriate nursing intervention is to sit by the crib, offer comfort, and wait until the child's anxiety decreases before proceeding with bathing. This approach allows the child to feel supported and gradually transition to accepting care. Choice A is incorrect because forcing comfort may escalate the child's distress. Choice B is inappropriate as it disregards the child's emotional state and rushes into the bathing procedure. Choice D is not ideal as it suggests delaying care for an extended period, which may not address the child's immediate needs for comfort and hygiene.

3. A nurse is providing care to a child diagnosed with sickle cell anemia. What is the priority nursing intervention?

• A. Administering pain medication
• B. Ensuring adequate hydration
• C. Providing nutritional support
• D. Monitoring vital signs

Correct answer: A

Rationale: In sickle cell anemia, pain management is a priority due to vaso-occlusive crises that cause severe pain. Administering pain medication helps alleviate discomfort and improve the child's quality of life. Ensuring adequate hydration, although important, is secondary to addressing the immediate pain issue. Providing nutritional support is beneficial for overall health but does not address the acute pain experienced. Monitoring vital signs is essential but not the immediate priority when managing pain in sickle cell anemia.

4. Which cardiac defects are associated with tetralogy of Fallot?

• A. Right ventricular hypertrophy, atrial and ventricular defects, and mitral valve stenosis
• B. Origin of the aorta from the right ventricle and of the pulmonary artery from the left ventricle
• C. Right ventricular hypertrophy, ventricular septal defect, pulmonic stenosis, and overriding aorta
• D. Altered connection between the pulmonary artery and the aorta, right ventricular hypertrophy, and an atrial septal defect

Correct answer: C

Rationale: Tetralogy of Fallot is characterized by a combination of four specific cardiac defects: right ventricular hypertrophy, ventricular septal defect, pulmonic stenosis, and overriding aorta. Choice A is incorrect as it includes mitral valve stenosis, which is not typically part of tetralogy of Fallot. Choice B describes transposition of the great arteries rather than tetralogy of Fallot. Choice D includes an atrial septal defect, which is not part of the classic presentation of tetralogy of Fallot.

5. An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 p.m. The fracture was reduced in the emergency department and her arm placed in a cast. At 11 p.m. her mother brings her back to the emergency department due to unrelenting pain that has not been relieved by the prescribed narcotics. Which action would be the priority?

• A. Notifying the doctor immediately
• B. Applying ice
• C. Elevating the arm
• D. Giving additional pain medication as ordered

Correct answer: A

Rationale: The correct action would be to notify the doctor immediately. Unrelenting pain despite medication can indicate compartment syndrome, which is a medical emergency requiring immediate attention. Applying ice, elevating the arm, or giving additional pain medication may not address the underlying cause of the unrelenting pain, which could be a sign of a serious complication like compartment syndrome. Prompt medical evaluation is crucial in this situation to prevent potential complications.

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