Nursing Elites

1. In a 12-year-old child with a history of epilepsy brought to the emergency department after experiencing a 10-minute seizure, what is the nurse’s priority intervention?

• A. Administer oxygen
• B. Administer antiepileptic medication as prescribed
• C. Monitor the child’s vital signs
• D. Check the child’s blood glucose level

Correct answer: B

Rationale: Administering antiepileptic medication as prescribed is the priority intervention in a child with a history of epilepsy who experienced a prolonged seizure. This action is crucial to stop the seizure and prevent further complications associated with prolonged seizure activity. Administering oxygen may be necessary, but the priority is to stop the seizure. Monitoring vital signs and checking blood glucose levels are important but secondary to administering antiepileptic medication to manage the seizure.

2. The caregiver is providing discharge instructions to the parents of a 6-month-old infant who was hospitalized for bronchiolitis. Which statement by the parents indicates a correct understanding of the instructions?

• A. We should keep our baby away from people with colds
• B. We should continue giving the prescribed medication even if our baby seems better
• C. We should avoid giving solid foods to help with recovery
• D. We can place our baby to sleep on their back to help with breathing

Correct answer: A

Rationale: Keeping the infant away from people with colds is crucial to prevent the spread of respiratory infections, especially for infants recently hospitalized with bronchiolitis. This precaution helps protect the baby from further illnesses and promotes recovery. The other choices are incorrect because it is important to complete the prescribed medication course even if the baby seems better to ensure the infection is fully treated (Choice B). Solid foods are usually introduced around six months of age, so avoiding them entirely may not be necessary (Choice C). Placing the baby to sleep on their back is a safe sleep practice to prevent sudden infant death syndrome (SIDS) but may not directly help with breathing in the context of bronchiolitis (Choice D).

3. A 3-year-old child is brought to the clinic by the parents who are concerned that the child is not yet potty trained. What is the nurse’s best response?

• A. Most children are potty trained by this age, so you should not be concerned
• B. Every child develops at their own pace. Let’s discuss some strategies to help
• C. Your child may need to be evaluated for developmental delays
• D. It’s best to force your child to use the potty to encourage training

Correct answer: B

Rationale: The correct answer is B because it is important to acknowledge that children develop at different rates. By offering support and discussing strategies for potty training, the nurse can provide the necessary guidance without causing unnecessary concern or pressure on the parents. Choice A is incorrect because it dismisses the parents' concerns. Choice C is incorrect because jumping to the conclusion of developmental delays without further assessment or discussion can cause undue anxiety. Choice D is incorrect because forcing a child to use the potty can lead to resistance and negative associations with potty training.

4. When should a mother introduce solid foods to her 4-month-old baby girl? The mother states, 'My mother says I should put rice cereal in the baby's bottle now.' The nurse should instruct the mother to introduce solid foods when her child exhibits which behavior?

• A. Stops rooting when hungry
• B. Opens mouth when food comes her way
• C. Awakens once for nighttime feedings
• D. Gives up a bottle for a cup

Correct answer: B

Rationale: The correct answer is B: 'Opens mouth when food comes her way.' This behavior indicates readiness to start trying solid foods. Infants should be introduced to solid foods based on developmental cues, such as showing an interest in food and the ability to accept it. Choices A, C, and D are not indicative of readiness for solid foods. Stopping rooting when hungry is a reflex that may persist beyond the readiness for solids. Awakening for nighttime feedings is a normal behavior for a 4-month-old, and transitioning from a bottle to a cup is a later developmental milestone.

5. What action should the nurse implement when the infusion of chemotherapy via an implanted medication port is complete for a 16-year-old with acute myelocytic leukemia at the outpatient oncology clinic?

• A. Administer Zofran
• B. Obtain blood samples for RBCs, WBCs, and platelets
• C. Flush mediport with saline and heparin solution
• D. Initiate an infusion of normal saline

Correct answer: C

Rationale: The correct action for the nurse to implement when the chemotherapy infusion is complete is to flush the mediport with saline and heparin solution. This process helps prevent clotting and ensures the patency of the port, which is essential for future medication administrations and blood draws. Administering Zofran (Choice A) is not necessary after completing the chemotherapy infusion. Obtaining blood samples (Choice B) for RBCs, WBCs, and platelets is important but not the immediate action after completing the infusion. Initiating an infusion of normal saline (Choice D) is not required unless there is a specific indication for it.

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