Nursing Elites

1. A 10-year-old child with hemophilia is admitted to the hospital with joint pain and swelling. What should the healthcare provider do first?

• A. Apply ice to the affected joint
• B. Administer pain medication
• C. Elevate the affected limb
• D. Administer factor VIII as prescribed

Correct answer: D

Rationale: Administering factor VIII as prescribed is the priority intervention for a child with hemophilia experiencing joint pain and swelling. Hemophilia is a genetic disorder that impairs the blood's ability to clot properly, leading to prolonged bleeding. Factor VIII replacement therapy is essential as it helps restore the missing clotting factor in patients with hemophilia, thereby aiding in clot formation and preventing further bleeding. Applying ice, administering pain medication, or elevating the limb may be supportive measures but addressing the underlying cause by providing factor VIII therapy takes precedence in managing hemophilia-related joint pain and swelling.

2. What suggestion should the nurse provide to prevent diaper rash in a 4-month-old infant as requested by the mother?

• A. Generously powder the baby's diaper area with talcum powder at each diaper change to promote dryness.
• B. Wash the diaper area every 2 hours with soap and water to help prevent skin breakdown.
• C. Use a barrier cream, such as zinc oxide, which does not have to be completely removed with each diaper change.
• D. Place a cloth diaper inside the disposable diaper for overnight periods when increased wearing time is likely.

Correct answer: C

Rationale: Using a barrier cream like zinc oxide forms a protective layer on the skin, creating a barrier against irritants and moisture, thus helping to prevent diaper rash. Unlike other options, barrier creams do not need to be completely removed at each diaper change, allowing the skin to remain protected between changes.

3. When obtaining the nursing history of a 7-year-old child admitted to the hospital with acute glomerulonephritis (AGN), which finding should the nurse expect to obtain?

• A. High blood cholesterol level on routine screening.
• B. Increased thirst and urination.
• C. A recent strep throat infection.
• D. A recent DPT immunization.

Correct answer: C

Rationale: When assessing a child with acute glomerulonephritis (AGN), a common trigger to expect in the nursing history is a recent strep throat infection. AGN can be triggered by a streptococcal infection, leading to the deposition of immune complexes in the glomeruli. This finding is crucial as it helps identify a potential cause for the development of AGN in the child. Choices A, B, and D are incorrect as high blood cholesterol levels, increased thirst and urination, and recent DPT immunization are not directly associated with triggering acute glomerulonephritis in children.

4. When should oral hygiene practices start for an infant according to the American Dental Association guidelines?

• A. There is no need to begin until after all of the child's baby teeth are in.
• B. You don't have to worry about that until your child can handle a toothbrush.
• C. You can begin now using toothpaste on a gauze pad and wiping the gums.
• D. Begin wiping the teeth with a washcloth and water when the first tooth appears.

Correct answer: D

Rationale: According to the American Dental Association guidelines, oral hygiene practices should start as soon as the first tooth appears. At this stage, using a soft cloth and water to clean the infant's gums and teeth is recommended to establish good oral hygiene habits early on and prevent dental issues. Choice A is incorrect as waiting until all baby teeth are in is too late for starting oral hygiene practices. Choice B is incorrect as it is essential to start oral hygiene before the child can handle a toothbrush. Choice C is incorrect as using toothpaste on a gauze pad is not recommended for infants with emerging teeth.

5. What should the nurse do first for a 6-year-old with asthma showing a prolonged expiratory phase, wheezing, and 35% of personal best peak expiratory flow rate (PEFR)?

• A. Administer a prescribed bronchodilator.
• B. Encourage the child to cough and take deep breaths.
• C. Report the findings to the healthcare provider.
• D. Identify the triggers that precipitated this attack.

Correct answer: A

Rationale: Administering a bronchodilator is the priority action in managing an acute asthma exacerbation in a child. Bronchodilators help to relax the muscles around the airways, opening them up and improving breathing. This intervention aims to address the immediate breathing difficulty and should be done promptly to provide relief for the child. Encouraging coughing and deep breaths (choice B) may worsen the child's condition by further constricting the airways. Reporting findings to the healthcare provider (choice C) is important but not the immediate priority in this acute situation. Identifying triggers (choice D) is crucial for long-term asthma management but is not the first step when managing an acute exacerbation.

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