Nursing Elites

1. When caring for a child with Kawasaki disease, which symptom is the most significant for making this diagnosis?

• A. Desquamation of the palms and soles.
• B. Cervical lymphadenopathy.
• C. Erythema of the hands and feet.
• D. Strawberry tongue.

Correct answer: C

Rationale: Erythema of the hands and feet is a key diagnostic criterion for Kawasaki disease. This, along with other symptoms like fever and strawberry tongue, helps in making the diagnosis. While desquamation of the palms and soles, cervical lymphadenopathy, and strawberry tongue are associated with Kawasaki disease, the presence of erythema of the hands and feet is particularly significant in diagnosing this condition.

2. The healthcare provider is caring for a 6-year-old child diagnosed with glomerulonephritis. Which finding should the healthcare provider report promptly to the healthcare provider?

• A. Dark-colored urine
• B. Mild periorbital edema
• C. Blood pressure of 150/95 mm Hg
• D. Urine output of 250 mL in 24 hours

Correct answer: C

Rationale: Hypertension is a serious complication of glomerulonephritis, as it can lead to further renal damage. A blood pressure reading of 150/95 mm Hg is elevated and should be reported promptly to the healthcare provider for immediate management to prevent complications. Dark-colored urine can be a common symptom of glomerulonephritis due to blood in the urine but is not as urgent as managing hypertension. Mild periorbital edema can also be seen in glomerulonephritis but is not as concerning as elevated blood pressure. Urine output of 250 mL in 24 hours indicates oliguria, which is a concern, but addressing hypertension takes priority to prevent further renal damage.

3. When a mother of a 3-year-old boy gives birth to a baby girl and the boy asks why his baby sister is breastfeeding from their mother, how should the nurse respond? Select the option that is not appropriate.

• A. Remind him that his mother breastfed him too
• B. Clarify that breastfeeding is the mother's choice
• C. Reassure the older brother that it does not hurt his mother
• D. Explain that newborns get milk from their mothers in this way

Correct answer: B

Rationale: Choice B is not the appropriate response in this scenario. The correct answer is choice A, which normalizes the situation for the child by reminding him that his mother breastfed him too. This response helps the older brother understand that breastfeeding is a natural and common practice for newborns, including his baby sister, just as it was for him when he was a baby. Choice B, while true, does not directly address the child's question and may not provide the same level of reassurance and normalization as choice A. Choices C and D also do not directly answer the child's question and do not provide the same level of connection and understanding as choice A.

4. During a follow-up clinical visit, a mother tells the nurse that her 5-month-old son, who had surgical correction for tetralogy of Fallot, has rapid breathing, often takes a long time to eat, and requires frequent rest periods. The infant is not crying while being held, and his growth is in the expected range. Which intervention should the nurse implement?

• A. Stimulate the infant to cry to produce cyanosis
• B. Auscultate the heart and lungs while holding the infant
• C. Evaluate the infant for failure to thrive
• D. Obtain a 12-lead electrocardiogram

Correct answer: B

Rationale: Auscultating the heart and lungs while the infant is held is the most appropriate intervention to assess his current condition. This action allows the nurse to gather important information regarding the cardiovascular and respiratory status of the infant, which is crucial in evaluating his post-surgical recovery and overall well-being. Option A is incorrect as stimulating the infant to cry intentionally is not necessary and could cause distress. Option C is incorrect as the infant's growth is within the expected range, indicating no signs of failure to thrive. Option D is incorrect as obtaining a 12-lead electrocardiogram is not the initial intervention needed in this situation; assessing the heart and lungs through auscultation is more immediate and informative.

5. What information should the practical nurse ensure the family understands about caring for a child with a tracheostomy?

• A. Cardiopulmonary resuscitation.
• B. Hygiene practices, including showering.
• C. Proper technique for tracheostomy suctioning.
• D. Application of powder around the stoma.

Correct answer: A

Rationale: The correct answer is A: Cardiopulmonary resuscitation. It is essential for families to be educated in cardiopulmonary resuscitation (CPR) to manage emergencies involving patients with tracheostomies. Maintaining a clear airway is crucial for the child's safety and well-being. Choice B, hygiene practices, although important, is not as critical as CPR in managing a tracheostomy. Choice C, the proper technique for tracheostomy suctioning, is also crucial but does not take precedence over CPR in emergency situations. Choice D, application of powder around the stoma, is not a standard practice and may not be necessary for tracheostomy care.

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