Nursing Elites

1. What is the best indicator of fluid balance in a pediatric patient?

• A. Blood pressure
• B. Heart rate
• C. Weight
• D. Urine output

Correct answer: C

Rationale: Weight is the most accurate indicator of fluid balance in pediatric patients. Changes in weight reflect shifts in body fluid levels more directly compared to other parameters. Blood pressure and heart rate may be affected by various factors other than fluid balance. While urine output is important in assessing renal function, it may not provide a comprehensive picture of overall fluid balance in pediatric patients.

2. When checking the intravenous (IV) site on a child, the nurse should take which action?

• A. Look at the site.
• B. Ask the child if the site hurts.
• C. Look at the site while palpating the area.
• D. Take all the tape off, assess the site, and redress.

Correct answer: C

Rationale: Looking at and palpating the IV site helps assess for signs of infiltration or infection, such as swelling, redness, or pain. Simply looking or asking the child may miss subtle signs, and removing all the tape unnecessarily disrupts the site.

3. The mother of a child with cognitive impairment calls the nurse because her son has been gagging and drooling all morning. The nurse suspects foreign body ingestion. What physiologic occurrence is most likely responsible for the presenting signs?

• A. Gastrointestinal perforation may have occurred.
• B. The object may have been aspirated.
• C. The object may be lodged in the esophagus.
• D. The object may be embedded in the stomach wall.

Correct answer: C

Rationale: The symptoms of gagging and drooling suggest that the foreign object is likely lodged in the esophagus. This can cause significant discomfort and potential complications, requiring immediate medical evaluation.

4. A child has been diagnosed with a Wilms tumor. What should preoperative nursing care include?

• A. Careful bathing and handling
• B. Monitoring of behavioral status
• C. Maintenance of strict isolation
• D. Administration of packed red blood cells

Correct answer: A

Rationale: The correct answer is A: Careful bathing and handling. Preoperative care for a child with a Wilms tumor should focus on preventing any trauma to the abdomen, which could lead to tumor rupture. Monitoring behavioral status and maintaining strict isolation are not as critical in this situation. Behavioral status is important but not a priority in preoperative care for a Wilms tumor. Strict isolation is not necessary unless there are specific infectious concerns, which is not typically the case for a Wilms tumor. Administration of packed red blood cells is not a standard preoperative intervention for Wilms tumor.

5. An infant with short bowel syndrome is receiving total parenteral nutrition (TPN). The practitioner has added continuous enteral feedings through a gastrostomy tube. The nurse recognizes this as important for which reason?

• A. Wean the infant from TPN gradually
• B. Stimulate adaptation of the small intestine
• C. Provide additional nutrients that cannot be included in the TPN
• D. Offer parents encouragement that the child is close to discharge

Correct answer: B

Rationale: Continuous enteral feedings help stimulate the small intestine's adaptation in short bowel syndrome, promoting better nutrient absorption and eventually reducing reliance on TPN. This approach is crucial for long-term management and improving the child's prognosis. Choice A is incorrect because weaning off TPN typically occurs gradually over time, not the next day. Choice C is incorrect because TPN can be adjusted to provide necessary nutrients, and enteral feedings are mainly used to stimulate intestinal function. Choice D is incorrect as the addition of enteral feedings does not necessarily indicate imminent discharge; it primarily focuses on enhancing intestinal adaptation and reducing reliance on TPN.

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