Nursing Elites

1. A 2-year-old child with a diagnosis of atopic dermatitis is being discharged. What should the nurse include in the discharge teaching?

• A. Avoid triggers that cause flare-ups
• B. Apply topical corticosteroids as prescribed
• C. Use a soft toothbrush for oral care
• D. Avoid contact with sick individuals

Correct answer: B

Rationale: The correct answer is to apply topical corticosteroids as prescribed. Atopic dermatitis is a chronic inflammatory skin condition that can be managed with topical corticosteroids to reduce inflammation and itching. While avoiding triggers that cause flare-ups is important in managing atopic dermatitis, the primary treatment approach involves using prescribed medications like corticosteroids. Using a soft toothbrush for oral care and avoiding contact with sick individuals are not directly related to managing atopic dermatitis and are not the priority discharge teachings in this case.

2. You are called to a residence for a "sick" 5-year-old child. When you arrive and begin your assessment, you note that the child is unconscious with a respiratory rate of 8 breaths/min and a heart rate of 50 beats/min. Management of this child should consist of

• A. 100% oxygen via a non-rebreathing mask and rapid transport
• B. positive pressure ventilations with a BVM device and rapid transport
• C. chest compressions, artificial ventilations, and rapid transport
• D. back blows and chest thrusts while attempting artificial ventilations

Correct answer: C

Rationale: In a pediatric patient with an unconscious state, a respiratory rate of 8 breaths/min, and a heart rate of 50 beats/min, the appropriate management involves chest compressions, artificial ventilations, and rapid transport. These signs indicate severe respiratory and circulatory compromise, requiring immediate intervention to support breathing and circulation. Choice A (100% oxygen via a non-rebreathing mask) is not sufficient in this critical situation as the child requires more than just oxygen supplementation. Choice B (positive pressure ventilations with a BVM device) may be needed, but chest compressions are crucial in this scenario due to the presence of bradycardia. Choice D (back blows and chest thrusts) are not indicated for an unconscious child with respiratory and circulatory compromise; instead, immediate chest compressions are necessary to provide circulatory support.

3. The parent of a 2-year-old child is informed by the nurse that the toddler’s negativism is expected at this age. What need is this behavior meeting?

• A. Trust
• B. Attention
• C. Discipline
• D. Independence

Correct answer: D

Rationale: Negativism in toddlers commonly occurs around the age of 2 as they begin to assert their independence and autonomy. At this stage, children are exploring their own will and preferences, leading to behaviors like defiance or negativism. Independence (choice D) is the primary need being met by this behavior as toddlers strive to establish their individuality and decision-making. While trust (choice A) is crucial for forming secure attachments, it is not the main need driving negativism in this case. Seeking attention (choice B) may be a behavior exhibited by children, but it is not the fundamental need being fulfilled by negativism. Discipline (choice C) is important for setting boundaries and teaching appropriate conduct, but it is not the primary need being addressed by negativism in toddlers.

4. After clearing the airway of a newborn who is not in distress, what is the most important action to take next?

• A. Administer free-flow oxygen
• B. Clamp and cut the cord
• C. Keep the newborn warm
• D. Obtain an APGAR score

Correct answer: C

Rationale: Keeping the newborn warm is crucial immediately after clearing the airway to prevent hypothermia, which can lead to complications in newborns. Administering free-flow oxygen is not necessary if the newborn is not in distress. Clamping and cutting the cord can be done after ensuring the newborn's warmth. Obtaining an APGAR score is important but can be done after ensuring the newborn is kept warm and stable.

5. A 3-year-old child has a sudden onset of respiratory distress. The mother denies any recent illnesses or fever. You should suspect

• A. croup
• B. epiglottitis
• C. lower respiratory infection
• D. foreign body airway obstruction

Correct answer: D

Rationale: In a 3-year-old child presenting with sudden respiratory distress and no history of recent illnesses or fever, foreign body airway obstruction should be suspected. Foreign body airway obstruction commonly leads to acute respiratory distress without preceding symptoms. Croup (Choice A) typically presents with a barking cough and stridor. Epiglottitis (Choice B) often presents with high fever, drooling, and a muffled voice. Lower respiratory infection (Choice C) may manifest with symptoms such as cough, fever, and respiratory distress, but the sudden onset without fever or recent illness suggests a more acute event like foreign body airway obstruction.

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