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. What is the most important information for the PN to reinforce with the parents when caring for a child diagnosed with acute rheumatic fever?

• A. Complete the full course of prescribed antibiotics.
• B. Ensure the child gets plenty of physical exercise.
• C. Keep the child on a low-sodium diet.
• D. Administer prescribed pain medications as needed.

Correct answer: A

Rationale: Completing the full course of antibiotics is crucial in the management of acute rheumatic fever as it helps prevent recurrence and complications. Antibiotics are essential in eradicating the underlying infection that triggers the autoimmune response leading to rheumatic fever. Reinforcing the importance of completing the prescribed antibiotic regimen is vital to ensure the child's recovery and prevent further health issues. Choices B, C, and D are not as critical as completing the antibiotic treatment. While physical exercise, a low-sodium diet, and pain management are important aspects of overall health, they are not the primary focus when managing acute rheumatic fever.

3. A child who weighs 25 kg is receiving IV ampicillin at a dose of 300 mg/kg/24 hours in equally divided doses every 4 hours. How many milligrams should the nurse administer to the child for each dose?

• A. 1875 mg
• B. 625 mg
• C. 2000 mg
• D. 1500 mg

Correct answer: A

Rationale: To calculate the correct dose for each administration, you first need to find the total daily dose: 300 mg/kg * 25 kg = 7500 mg/day. Since this total dose is divided into equally divided doses every 4 hours, there are 6 doses in 24 hours. Therefore, 7500 mg ÷ 6 doses = 1250 mg per dose. The nurse should administer 1250 mg every 4 hours, resulting in a total of 1875 mg for each dose in a 24-hour period. Choice A, 1875 mg, is the correct answer. Choice B, 625 mg, is incorrect as it does not consider the total daily dose and the frequency of administration. Choice C, 2000 mg, is incorrect as it is not the calculated dosage based on the given parameters. Choice D, 1500 mg, is also incorrect as it does not reflect the correct dosage calculation for each dose.

4. The nurse is planning for a 5-month-old with gastroesophageal reflux disease whose weight has decreased by 3 ounces since the last clinic visit one month ago. To increase caloric intake and decrease vomiting, what instructions should the nurse provide this mother?

• A. Give small amounts of baby food with each feeding.
• B. Thicken formula with cereal for each feeding.
• C. Dilute the child's formula with equal parts of water.
• D. Offer 10% dextrose in water between most feedings.

Correct answer: B

Rationale: Thickening formula with cereal is a recommended intervention for infants with gastroesophageal reflux disease (GERD) to help reduce vomiting and increase caloric intake. This modification can help the infant keep the food down better, reducing reflux symptoms while providing adequate nutrition. Giving small amounts of baby food with each feeding (Choice A) is not recommended for a 5-month-old with GERD as it may exacerbate symptoms. Diluting the child's formula with equal parts of water (Choice C) can lead to inadequate nutrition and is not advisable. Offering 10% dextrose in water between most feedings (Choice D) is not appropriate for managing GERD in infants and does not address the underlying issue of reflux.

5. What advice should be provided by the practical nurse to the mother of a school-age child with acute diarrhea and mild dehydration who is occasionally vomiting despite being given an oral rehydration solution (ORS)?

• A. Continue to give ORS frequently in small amounts.
• B. Alternate between ORS and carbonated beverages.
• C. Take the child to the hospital for intravenous fluids.
• D. Place the child NPO for the next eight to nine hours.

Correct answer: A

Rationale: The practical nurse should advise the mother to continue providing the oral rehydration solution (ORS) frequently in small amounts. It is essential to continue ORS administration to prevent dehydration, even if the child is occasionally vomiting. Small, frequent amounts of ORS help maintain hydration levels in children with acute diarrhea and mild dehydration.

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