Nursing Elites

1. While auscultating the lung sounds of a 5-year-old Chinese boy who recently completed antibiotic therapy for pneumonia, the nurse notices symmetrical, round, bruise-like blemishes on his chest. What action is best for the nurse to take?

• A. Identify the antibiotics used for treating the pneumonia.
• B. Inquire about the use of alternative treatment methods.
• C. Ask the parents if the child has been in a recent accident.
• D. Report suspected child abuse to the authorities.

Correct answer: B

Rationale: Inquiring about the use of alternative treatment methods is essential to understand cultural practices and provide holistic care. It allows the nurse to gather more information about the blemishes and potentially uncover traditional or alternative healing approaches that the family may have used. This approach demonstrates cultural sensitivity and a comprehensive assessment before making assumptions or taking further actions. Identifying the antibiotics used for treating pneumonia (Choice A) is not immediately necessary in this context as the focus is on the blemishes. Asking about a recent accident (Choice C) assumes a traumatic cause without evidence. Reporting suspected child abuse (Choice D) is premature without further assessment or evidence of abuse.

2. The nurse is planning for a 5-month-old with gastroesophageal reflux disease whose weight has decreased by 3 ounces since the last clinic visit one month ago. To increase caloric intake and decrease vomiting, what instructions should the nurse provide this mother?

• A. Give small amounts of baby food with each feeding.
• B. Thicken formula with cereal for each feeding.
• C. Dilute the child's formula with equal parts of water.
• D. Offer 10% dextrose in water between most feedings.

Correct answer: B

Rationale: Thickening formula with cereal is a recommended intervention for infants with gastroesophageal reflux disease (GERD) to help reduce vomiting and increase caloric intake. This modification can help the infant keep the food down better, reducing reflux symptoms while providing adequate nutrition. Giving small amounts of baby food with each feeding (Choice A) is not recommended for a 5-month-old with GERD as it may exacerbate symptoms. Diluting the child's formula with equal parts of water (Choice C) can lead to inadequate nutrition and is not advisable. Offering 10% dextrose in water between most feedings (Choice D) is not appropriate for managing GERD in infants and does not address the underlying issue of reflux.

3. The mother of a 9-month-old girl provides the practical nurse with information about her daughter's diet. Which statement by the mother may indicate why the infant has been diagnosed with iron-deficiency anemia?

• A. She almost never drinks sugary water.
• B. She has been on whole milk for 7 months.
• C. She likes to chew on bread as a snack.
• D. She doesn't like to eat peaches or pears.

Correct answer: B

Rationale: The correct answer is B. Infants should not be given cow's milk before 1 year of age as it can interfere with iron absorption and lead to anemia. Choice A is incorrect as avoiding sugary water is actually a good practice. Choice C is unrelated to iron-deficiency anemia. Choice D, not liking peaches or pears, is also not directly related to iron-deficiency anemia.

4. A 7-year-old child with leukemia is receiving chemotherapy. The mother asks the practical nurse (PN) how to manage the child's nausea at home. What advice should the PN provide?

• A. Provide small, frequent meals.
• B. Encourage the child to eat spicy foods.
• C. Offer large meals less frequently.
• D. Allow the child to eat whatever they want.

Correct answer: A

Rationale: During chemotherapy, children may experience nausea. Providing small, frequent meals can help manage nausea as they are easier to tolerate, reducing the likelihood of vomiting. It is important to offer bland, non-spicy foods to avoid exacerbating nausea. Encouraging large meals less frequently or allowing the child to eat whatever they want may overwhelm the digestive system and worsen nausea. Therefore, the correct advice is to provide small, frequent meals to help the child manage nausea effectively.

5. A child admitted with diabetic ketoacidosis is demonstrating Kussmaul respirations. The nurse determines that the increased respiratory rate is a compensatory mechanism for which acid-base alteration?

• A. Metabolic alkalosis.
• B. Respiratory acidosis.
• C. Respiratory alkalosis.
• D. Metabolic acidosis.

Correct answer: D

Rationale: Kussmaul respirations are deep, rapid breathing patterns observed in metabolic acidosis, such as diabetic ketoacidosis. In this condition, the body tries to compensate for the acidic environment by increasing the respiratory rate to eliminate excess carbon dioxide (CO2) and decrease the acid levels, thereby helping to correct the acid-base imbalance. Therefore, the correct answer is metabolic acidosis.

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