Nursing Elites

1. Which factor is most likely to cause a "brittle" diabetic state in a child with type 1 diabetes?

• A. Noncompliance with diet
• B. Insulin resistance
• C. Frequent infections
• D. Hypothyroidism

Correct answer: C

Rationale: Frequent infections can destabilize blood sugar levels, leading to a "brittle" diabetic state in children with type 1 diabetes. Infections increase metabolic demands and can result in significant blood glucose fluctuations, requiring careful monitoring and adjustment of insulin therapy. Noncompliance with diet may affect blood sugar control but is not the primary cause of a "brittle" state. Insulin resistance is more common in type 2 diabetes rather than type 1. Hypothyroidism can impact metabolism but is not directly linked to the development of a "brittle" diabetic state in type 1 diabetes.

2. The nurse is preparing to administer a prescribed, as-needed antiemetic drug for a child diagnosed with cancer. Which action by the nurse is most appropriate?

• A. Administering the drug only if the child is nauseated.
• B. Administering the drug prophylactically before the next dose of chemotherapy.
• C. Administering the drug after the next dose of chemotherapy.
• D. Administering the drug only if the child is experiencing diarrhea.

Correct answer: B

Rationale: Administering the antiemetic prophylactically before the next dose of chemotherapy is the most appropriate action. This approach helps prevent nausea and vomiting associated with chemotherapy. Waiting until the child is already nauseated, as stated in option A, is less effective as it is reactive rather than proactive. Administering the drug after chemotherapy, as in option C, may not be as beneficial in preventing chemotherapy-induced nausea and vomiting. Option D, administering the drug only if the child is experiencing diarrhea, is not relevant to the prevention of chemotherapy-induced nausea.

3. The nurse is caring for a 2-year-old child in the postoperative period. Which pain assessment tool is most appropriate for assessing pain intensity in a 2-year-old?

• A. Poker chip tool
• B. Oucher Scale
• C. Faces Pain Rating Scale
• D. FLACC Behavioral Pain Assessment Scale

Correct answer: D

Rationale: The FLACC Behavioral Pain Assessment Scale is the most suitable tool for assessing pain in 2-year-old children postoperatively. It assesses pain by evaluating facial expression, leg movement, activity, cry, and consolability, making it effective for non-verbal children. The Poker chip tool is not appropriate for this age group. The Oucher Scale and Faces Pain Rating Scale are more suitable for older children who can self-report pain levels.

4. A child is admitted in acute renal failure (ARF). Therapeutic management to rapidly provoke a flow of urine includes the administration of what medication?

• A. Propranolol (Inderal)
• B. Calcium gluconate
• C. Mannitol (Osmitrol) or furosemide (Lasix)
• D. Sodium, chloride, and potassium

Correct answer: C

Rationale: Mannitol and furosemide are diuretics commonly used to induce diuresis in acute renal failure, helping to provoke urine flow and manage fluid overload. Calcium gluconate and electrolyte supplementation are used for other specific conditions and not primarily for diuresis.

5. A school-age child with cancer is being prepared for a procedure. The child says, “I have had one of these before. They hurt.” The nurse bases her response on what knowledge related to pain in this patient?

• A. Often misrepresent experiencing pain
• B. Tolerate pain better than adults
• C. Become accustomed to painful procedures
• D. Commonly experience treatment-related moderate to severe pain when they have cancer

Correct answer: D

Rationale: The correct answer is D. Pain is frequently reported by children with cancer, with around 84% experiencing it. Most children report moderate to severe pain, with about half finding it highly distressing. There is no evidence to suggest that children often misrepresent their pain experiences. Pain tolerance is not solely based on age but is a complex phenomenon. Children do not become accustomed to painful procedures, as each experience of pain is unique.

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