Nursing Elites

1. What should be the priority action when caring for a child with acute laryngotracheobronchitis?

• A. Initiate measures to reduce fever.
• B. Ensure delivery of humidified oxygen.
• C. Provide support to reduce apprehension.
• D. Continually assess the respiratory status.

Correct answer: D

Rationale: When caring for a child with acute laryngotracheobronchitis, the priority action should be to continually assess the respiratory status. This is crucial to detect early signs of respiratory distress, such as worsening stridor or increased work of breathing. Prompt intervention can prevent further deterioration of the child's condition. Initiating measures to reduce fever (Choice A) may be necessary but is not the priority in this situation. Ensuring delivery of humidified oxygen (Choice B) is important for maintaining oxygenation but should follow the assessment of respiratory status. Providing support to reduce apprehension (Choice C) is also important for the child's comfort but is not the priority over assessing and managing respiratory distress.

2. During a nap, a 3-year-old hospitalized child wets the bed. How should the nurse respond?

• A. Ask the child to help with remaking the bed.
• B. Put clean sheets on the bed over a rubber sheet.
• C. Change the child’s clothes without discussing the incident.
• D. Explain that children should call the nurse when they need to go to the bathroom.

Correct answer: C

Rationale: When a 3-year-old hospitalized child wets the bed during a nap, the nurse should respond by changing the child’s clothes without discussing the incident. This approach helps to maintain the child's dignity, avoid embarrassment, and reduce anxiety related to bedwetting. Asking the child to help with remaking the bed (Choice A) may not be appropriate as it could cause unnecessary distress. Putting clean sheets on the bed over a rubber sheet (Choice B) addresses the aftermath but does not directly address the child's needs. Explaining that children should call the nurse when they need to go to the bathroom (Choice D) may not be effective in this immediate situation of bedwetting during a nap.

3. A parent brings an 18-month-old toddler to the clinic. The parent states, 'My child is so difficult to please, has temper tantrums, and annoys me by throwing food from the table.' What is the nurse’s best response?

• A. “Toddlers need discipline to prevent the development of antisocial behaviors.”
• B. “Toddlers are learning to assert independence, and this behavior is expected at this age.”
• C. “It is best to leave the toddler alone in the crib after calmly explaining why the behavior is unacceptable.”
• D. “This is the way a toddler expresses needs, and this behavior is acceptable during the initiative stage of development.”

Correct answer: B

Rationale: The correct answer is B: 'Toddlers are learning to assert independence, and this behavior is expected at this age.' At 18 months old, toddlers are in the stage of developing autonomy and testing boundaries. It is normal for them to exhibit behaviors such as temper tantrums and defiance as they explore their independence. Choice A is incorrect as discipline at this age is more about setting limits and providing guidance rather than preventing antisocial behaviors. Choice C is inappropriate as leaving a toddler alone in a crib after explaining unacceptable behavior is not a recommended approach for managing toddler behavior. Choice D is incorrect as the described behavior is typical of toddlers asserting independence, not related to the initiative stage of development. The best response involves acknowledging the child's developmental stage and understanding that these behaviors are part of their normal growth and development.

4. 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 or elevating the arm may not address the potential serious underlying issue of compartment syndrome. Giving additional pain medication without further assessment could delay necessary intervention and potentially worsen the condition.

5. A parent calls the clinic because their child has ingested a small amount of household bleach. What should the nurse advise?

• A. Administer activated charcoal
• B. Induce vomiting immediately
• C. Call the poison control center
• D. Take the child to the emergency department

Correct answer: C

Rationale: The correct answer is to advise the parent to call the poison control center. When a child ingests household bleach, it is important to seek guidance from professionals who can provide specific and immediate advice on managing the situation. Administering activated charcoal (Choice A) is not recommended for household bleach ingestion. Inducing vomiting immediately (Choice B) can lead to further complications and is not the recommended first response. Taking the child to the emergency department (Choice D) should be done based on the advice received from the poison control center.

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