Nursing Elites

1. What is the appropriate treatment for a responsive 4-year-old child with a mild airway obstruction, respiratory distress, a strong cough, and normal skin color?

• A. Oxygen, back slaps, and transport.
• B. Subdiaphragmatic thrusts until the object is expelled.
• C. Assisted ventilations, back slaps, and transport.
• D. Supplemental oxygen and transport.

Correct answer: D

Rationale: For a responsive 4-year-old child with a mild airway obstruction, respiratory distress, a strong cough, and normal skin color, the appropriate treatment includes providing supplemental oxygen and arranging for transport to a healthcare facility. Oxygen helps alleviate the respiratory distress, and transport ensures the child receives further evaluation and care by healthcare professionals. Back slaps and subdiaphragmatic thrusts are not recommended for a child with a mild airway obstruction and normal skin color, as these interventions are typically reserved for more severe cases of airway obstruction.

2. Which of the following clinical signs would MOST suggest acute respiratory distress in a 2-month-old infant?

• A. Heart rate of 130 beats/min
• B. Respiratory rate of 30 breaths/min
• C. Abdominal breathing
• D. Grunting respirations

Correct answer: D

Rationale: Grunting respirations are a key clinical sign of acute respiratory distress in infants. Grunting is a protective mechanism where the infant exhales against a partially closed glottis to increase functional residual capacity and oxygenation. This is often seen in conditions such as respiratory distress syndrome, pneumonia, or other causes of respiratory compromise in infants. Monitoring respiratory patterns like grunting is crucial for early recognition and intervention in infants with respiratory distress. Choices A, B, and C are less specific to acute respiratory distress in infants. While an elevated heart rate and respiratory rate can be present in respiratory distress, grunting respirations are a more direct indicator of significant respiratory compromise in infants.

3. Physical abuse of a 4-year-old child should be suspected if you observe:

• A. purple and yellow bruises on the thighs.
• B. bruises on the anterior tibial area.
• C. the child clinging to his or her parent.
• D. curious siblings watching you.

Correct answer: A

Rationale: Purple and yellow bruises on protected areas like the thighs are concerning as they indicate bruises in various stages of healing, which is a red flag for physical abuse. Bruises on the anterior tibial area or a child clinging to a parent are not specific signs of physical abuse. Siblings watching you is unrelated to the suspicion of physical abuse in this scenario.

4. A 3-year-old child has been admitted to your pediatric ward. The doctor gave a provisional diagnosis of respiratory tract infection. After careful assessment and history, a final diagnosis of lower respiratory infection was made. Which of the following signs will confirm the diagnosis?

• A. Cough
• B. Fever
• C. Inability to lie supine
• D. Inability to eat

Correct answer: C

Rationale: Inability to lie supine is a characteristic sign of lower respiratory infection. This positioning preference is often seen in patients with lower respiratory infections due to discomfort or difficulty breathing when lying flat on their back. While cough and fever are common symptoms associated with respiratory infections, they are not specific to lower respiratory infections. Inability to eat may indicate general illness or discomfort but is not a specific indicator of lower respiratory infection.

5. Mr. Lopez has a 7-year-old son with growth hormone (GH) deficiency. He shares with the nurse the desire of his son to play ball games. However, his wife feels the child will be in danger since he is smaller than the other children. In planning anticipatory guidance for these parents, the nurse should keep in mind which of the following?

• A. The child should be allowed to play because doing so can foster healthy self-esteem
• B. The risk for fractures is increased because GH deficiency results in fragile bones
• C. Activity could aggravate insulin sensitivity, causing hyperglycemia
• D. Activity would aggravate the child's joints, already overtasked by obesity

Correct answer: A

Rationale: Children with GH deficiency may face challenges due to their size, but it is important to encourage their participation in activities like playing ball games to promote healthy self-esteem. Allowing the child to play can help in building confidence and a sense of accomplishment, which are essential for their overall well-being.

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