Nursing Elites

1. A 2-year-old child with heart failure (HF) is admitted for replacement of a graft for coarctation of the aorta. Prior to administering the next dose of digoxin (Lanoxin), the nurse obtains an apical heart rate of 128 bpm. What action should the nurse take?

• A. Determine the pulse deficit.
• B. Administer the scheduled dose.
• C. Calculate the safe dose range.
• D. Review the serum digoxin level.

Correct answer: B

Rationale: Administering the scheduled dose is appropriate in this scenario since the heart rate of 128 bpm is within an acceptable range for a 2-year-old child with heart failure. Monitoring for signs of digoxin toxicity is important; however, the immediate action required is to administer the scheduled dose as prescribed based on the heart rate assessment.

2. During a follow-up clinical visit, a mother tells the nurse that her 5-month-old son, who had surgical correction for tetralogy of Fallot, has rapid breathing, often takes a long time to eat, and requires frequent rest periods. The infant is not crying while being held, and his growth is in the expected range. Which intervention should the nurse implement?

• A. Stimulate the infant to cry to produce cyanosis
• B. Auscultate the heart and lungs while the infant is held
• C. Evaluate the infant for failure to thrive
• D. Obtain a 12-lead electrocardiogram

Correct answer: B

Rationale: Auscultating the heart and lungs while the infant is held can provide important diagnostic information in assessing the cardiac and respiratory status of the infant who had surgical correction for tetralogy of Fallot. This intervention can help the nurse identify any abnormal heart or lung sounds, which may indicate complications or issues that need further evaluation or intervention.

3. During a well-baby exam, a nurse finds that a 2-month-old's right testicle is not descended into the scrotum, but the left one is palpable. What should the nurse do?

• A. Ask if the right testis has been seen in the scrotum before
• B. Address potential concerns about future fertility
• C. Schedule an ultrasound to confirm the position of the testicle
• D. Prepare to obtain a urine specimen for culture

Correct answer: A

Rationale: The correct answer is to ask if the right testis has been seen in the scrotum before. The initial step in managing an undescended testicle is to determine if it has been previously observed in the scrotum or if this is a new finding. This information is crucial in deciding the next course of action. Choice B is incorrect because addressing future fertility concerns comes after confirming the status of the testicle. Choice C is unnecessary at this stage as the first step is to gather more history. Choice D is unrelated to the issue described and is not indicated in this scenario.

4. When reviewing the dietary guidelines for a child with nephrotic syndrome, which diet should the practical nurse reinforce with the parents?

• A. High protein.
• B. Low sodium.
• C. Low fat.
• D. High carbohydrate.

Correct answer: B

Rationale: The correct diet that the practical nurse should reinforce with the parents of a child with nephrotic syndrome is a low-sodium diet. This diet is crucial for managing fluid retention and reducing the risk of edema, which are common concerns in children with nephrotic syndrome.

5. The heart rate for a 3-year-old with a congenital heart defect has steadily decreased over the last few hours; it is now 76 bpm, whereas the previous reading 4 hours ago was 110 bpm. Which additional finding should be reported immediately to a healthcare provider?

• A. Oxygen saturation of 94%.
• B. Respiratory rate of 25 breaths/minute.
• C. Urine output of 20 mL/hr.
• D. Blood pressure of 70/40.

Correct answer: D

Rationale: A significant drop in heart rate and blood pressure should be reported immediately as it may indicate worsening of the congenital heart defect. A decrease in blood pressure to 70/40 is a critical finding that suggests potential cardiovascular compromise and requires urgent attention to prevent further deterioration. Oxygen saturation, respiratory rate, and urine output are important parameters, but in this scenario, the alarming decrease in blood pressure is a more critical finding that necessitates immediate reporting to the healthcare provider.

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