Nursing Elites

1. A 16-year-old female student with a history of asthma controlled with both an oral antihistamine and an albuterol (Proventil) metered-dose inhaler (MDI) comes to the school nurse. The student complains that she cannot sleep at night, feels shaky and her heart feels like it is 'beating a mile a minute.' Which information is most important for the nurse to obtain?

• A. When she last took the antihistamine.
• B. When her last asthma attack occurred.
• C. Duration of most asthma attacks.
• D. How often the MDI is used daily.

Correct answer: D

Rationale: The most important information for the nurse to obtain in this scenario is how often the MDI is used daily. This is crucial to assess if the symptoms the student is experiencing, such as insomnia, shakiness, and tachycardia, could be related to overuse of the inhaler. Overuse of albuterol can lead to side effects like tremors, palpitations, and difficulty sleeping, so understanding the frequency of MDI use is key in determining a potential cause for the student's symptoms. Options A, B, and C are not as pertinent in this situation as they do not directly address the possible link between the student's symptoms and the use of the albuterol MDI.

2. A 14-year-old adolescent with a history of substance abuse is brought to the emergency department by the parents, who suspect that the adolescent has relapsed. What is the nurse’s priority action?

• A. Obtain a urine sample for toxicology screening
• B. Discuss treatment options with the parents
• C. Establish a therapeutic relationship with the adolescent
• D. Administer a medication to reverse the effects of the substance

Correct answer: A

Rationale: In this scenario, the nurse's priority action should be to obtain a urine sample for toxicology screening. This step is crucial in identifying the substances involved in the relapse, which will guide appropriate treatment strategies. By knowing the specific substances, healthcare providers can tailor treatment plans effectively. Establishing a therapeutic relationship and discussing treatment options come after obtaining necessary diagnostic information to ensure a comprehensive care plan. Administering a medication to reverse substance effects is not the initial priority; identification of the substances through toxicology screening should precede any treatment intervention.

3. A mother brings her school-aged daughter to the pediatric clinic for evaluation of her anti-epileptic medication regimen. What information should the nurse provide to the mother?

• A. The medication dose will be tapered over a period of 2 weeks when being discontinued
• B. If seizures return, multiple medications will be prescribed for another 2 years
• C. A dose of valproic acid (Depakote) should be available in the event of status epilepticus
• D. Phenytoin (Dilantin) and phenobarbital (Luminal) should be taken for life

Correct answer: A

Rationale: Antiepileptic drugs should not be abruptly stopped as it may lead to seizure recurrence. Tapering the medication over a period of 2 weeks helps to prevent withdrawal effects and minimize the risk of seizures. Choice B is incorrect because starting multiple medications for seizure recurrence is not the first-line approach. Choice C is incorrect because valproic acid is not the first-line medication given in the event of status epilepticus. Choice D is incorrect because antiepileptic medications are usually evaluated over time and adjusted based on the individual's response; it is not always necessary to take them for life.

4. The mother of a 9-month-old, diagnosed with respiratory syncytial virus (RSV) yesterday, calls the clinic to inquire if it will be all right to take her infant to the first birthday party of a friend's child the following day. What response should the nurse provide this mother?

• A. The child will no longer be contagious, so no need to take any further precautions.
• B. Ensure there are no children under the age of 6 months around the infected child.
• C. The child can be around other children but should wear a mask at all times.
• D. Do not expose other children to RSV. It is highly contagious even without direct contact.

Correct answer: D

Rationale: The correct answer is D. RSV is highly contagious, even without direct contact. It is important to prevent the spread of the virus to other children, so the infected child should not attend the birthday party to avoid exposing other children to RSV. This is crucial to protect the health of other children who may be more vulnerable to the virus. Choices A, B, and C are incorrect. Choice A is incorrect as RSV remains contagious for a period of time, and precautions should be taken to prevent its spread. Choice B is incorrect because the age limit specified is not a reliable measure to prevent transmission. Choice C is incorrect as wearing a mask may not be sufficient to prevent the spread of RSV in a social setting like a birthday party.

5. When assessing the breath sounds of an 18-month-old child who is crying, what action should the healthcare professional take?

• A. Document that the assessment is not available because the child is crying.
• B. Ask the caregiver to quiet the child so breath sounds can be auscultated.
• C. Allow the child to play with a stethoscope to distract them during auscultation.
• D. Auscultate and document breath sounds, noting that the child was crying at the time.

Correct answer: C

Rationale: Allowing the child to play with a stethoscope can help distract them, making it easier to auscultate breath sounds. This approach can create a more cooperative and engaging environment for the child, facilitating a more accurate assessment of their breath sounds. Choice A is incorrect because it does not address the need for an assessment. Choice B is not ideal as it puts pressure on the caregiver and may not be effective in calming the child. Choice D is not the best option as it does not actively involve the child in the assessment process and may not provide an accurate representation of their breath sounds.

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