Nursing Elites

1. When assessing a child with acute respiratory infection, what nursing intervention(s) would be appropriate?

• A. Provide safe remedies to relieve the child's sore throat and cough
• B. All of these interventions
• C. Advise the mother to monitor for signs of pneumonia
• D. Ensure proper nutrition to prevent weight loss

Correct answer: B

Rationale: In the management of acute respiratory infection in a child, it is essential to address various aspects of care. Providing safe remedies to relieve symptoms like sore throat and cough (Choice A) helps in managing discomfort. Advising the mother to monitor for signs of pneumonia (Choice C) is crucial for early detection and intervention if complications arise. Ensuring proper nutrition (Choice D) is important for the child's overall health and immune function during illness. Therefore, all the listed interventions are appropriate in managing acute respiratory infection, making Choice B the correct answer. Choices A, C, and D are incorrect on their own as they address only specific aspects of care and not the comprehensive management of acute respiratory infection.

2. To individualize care for a client and ensure maximum participation in that care, what should the nurse consider as the most important factor in planning the said care?

• A. environment
• B. educational attainment
• C. health beliefs and practices
• D. health status

Correct answer: C

Rationale: The correct answer is C: health beliefs and practices. Health beliefs and practices directly influence a client's willingness and ability to participate in care. Understanding a client's health beliefs and practices helps the nurse tailor the care plan to align with the client's values and preferences. Choice A, environment, though important, may not be the most critical factor in individualizing care. Choice B, educational attainment, is relevant but not as significant as understanding the client's health beliefs and practices. Choice D, health status, is essential but does not address the individualization of care and maximizing participation as directly as health beliefs and practices.

3. A client was re-admitted to the hospital following a recent skull fracture. Which finding requires the nurse's immediate attention?

• A. Lethargy
• B. Agitation
• C. Ataxia
• D. Hearing loss

Correct answer: A

Rationale: Lethargy is a critical finding that requires the nurse's immediate attention when a client with a recent skull fracture is readmitted to the hospital. It can indicate increased intracranial pressure or other serious complications such as hemorrhage or infection. Addressing lethargy promptly is crucial to prevent further deterioration. Agitation, ataxia, and hearing loss are important to assess but do not signify the same level of urgency as lethargy in this context.

4. The nurse is caring for an acutely ill 10-year-old client. Which of the following assessments would require the nurse's immediate attention?

• A. Rapid bounding pulse
• B. Temperature of 38.5 degrees Celsius
• C. Profuse diaphoresis
• D. Slow, irregular respirations

Correct answer: D

Rationale: The correct answer is D, slow, irregular respirations. In an acutely ill child, this assessment can indicate impending respiratory failure or neurological compromise, necessitating immediate intervention. Rapid bounding pulse (choice A) may indicate tachycardia but is not as immediately concerning as compromised respirations. A temperature of 38.5 degrees Celsius (choice B) is elevated but may not be the most urgent concern unless accompanied by other symptoms. Profuse diaphoresis (choice C) can indicate increased sympathetic activity but is not as critical as respiratory compromise.

5. When a nurse from the surgical department is reassigned to the pediatric unit, the charge nurse should recognize that the child at highest risk for cardiac arrest and is the least likely to be assigned to this nurse is which child?

• A. Congenital cardiac defects
• B. An acute febrile illness
• C. Prolonged hypoxemia
• D. Severe multiple trauma

Correct answer: C

Rationale: The correct answer is C, 'Prolonged hypoxemia.' Prolonged hypoxemia is a critical condition that requires specialized pediatric care due to the high risk of cardiac arrest. The other choices, such as congenital cardiac defects, acute febrile illness, and severe multiple trauma, may also require attention, but prolonged hypoxemia poses the highest risk for cardiac arrest and demands specialized expertise in managing pediatric patients with this condition.

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