Nursing Elites

1. A 15-month-old child is brought to the clinic for a routine checkup. The nurse notes that the child is not walking independently yet. What should the nurse do next?

• A. Refer the child for a developmental assessment
• B. Encourage the parents to start physical therapy
• C. Reassure the parents that some children walk later than others
• D. Discuss the importance of early intervention services

Correct answer: C

Rationale: The correct answer is to reassure the parents that some children walk later than others. It is essential to understand that children reach developmental milestones at different ages. Walking independently can occur later in some children, and it is normal. Referring the child for a developmental assessment (Choice A) may cause unnecessary concern at this stage. Encouraging physical therapy (Choice B) or discussing early intervention services (Choice D) may not be warranted unless there are specific concerns identified during the checkup.

2. What intervention should the nurse implement first for a male toddler brought to the emergency center approximately three hours after swallowing tablets from his grandmother’s bottle of digoxin (Lanoxin)?

• A. Administer activated charcoal orally
• B. Prepare gastric lavage
• C. Obtain a 12-lead electrocardiogram
• D. Give IV digoxin immune fab (Digibind)

Correct answer: D

Rationale: In cases of digoxin toxicity, IV digoxin immune fab (Digibind) is the antidote and should be administered first to counteract the effects of digoxin poisoning. This intervention is crucial in managing digoxin overdose and should be initiated promptly to improve patient outcomes. Activated charcoal and gastric lavage are not effective in treating digoxin poisoning and may not be beneficial at this stage. While obtaining an electrocardiogram is important to assess cardiac function, administering the antidote should take precedence to address the immediate life-threatening effects of digoxin toxicity.

3. When observing a distraught mother scolding her 3-year-old son for wetting his pants in the hallway of a pediatric unit, what initial action should the nurse take?

• A. Suggest that the mother consult a pediatric nephrologist.
• B. Provide disposable training pants while calming the mother.
• C. Refer the mother to a community parent education program.
• D. Inform the mother that toilet training is slower for boys.

Correct answer: B

Rationale: In this situation, the nurse's initial action should be to provide disposable training pants to manage the immediate issue of wetting while also calming the mother. This approach addresses the current distressing situation and offers a practical solution to alleviate the mother's concerns.

4. The healthcare provider is assessing a child for neurological soft signs. Which finding is most likely demonstrated in the child's behavior?

• A. Inability to move the tongue in a specific direction.
• B. Presence of vertigo.
• C. Poor coordination and sense of position.
• D. Loss of visual acuity.

Correct answer: C

Rationale: Neurological soft signs in children often manifest as poor coordination and a sense of position. These signs can indicate underlying neurological issues and are important to assess in pediatric patients. Choices A, B, and D are less likely to be associated with neurological soft signs in children. Inability to move the tongue in a specific direction may suggest a cranial nerve dysfunction rather than general neurological soft signs. Presence of vertigo is more related to inner ear disturbances or vestibular issues. Loss of visual acuity may indicate problems with the eyes rather than general neurological soft signs.

5. A 10-year-old child is admitted with diabetic ketoacidosis (DKA). Which laboratory value should the practical nurse (PN) anticipate?

• A. Elevated blood glucose.
• B. Decreased serum ketones.
• C. Low urine glucose.
• D. High bicarbonate levels.

Correct answer: A

Rationale: In a case of diabetic ketoacidosis (DKA), the primary feature is elevated blood glucose levels due to insulin deficiency. Additionally, ketones are increased in the blood and urine. Bicarbonate levels are usually low because of the metabolic acidosis that accompanies DKA. Therefore, the practical nurse should anticipate elevated blood glucose levels as a characteristic laboratory finding in a child admitted with DKA. Choice B is incorrect because serum ketones are increased in DKA. Choice C is incorrect because in DKA, urine glucose is typically high due to spillage of glucose into the urine. Choice D is incorrect because bicarbonate levels are usually low in DKA, not high.

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