Nursing Elites

1. A 2-year-old child with laryngotracheobronchitis (LTB) is fussy and restless in the oxygen tent. The oxygen level in the tent is 25%, and blood gases are normal. What would be the correct action by the nurse?

• A. Restrain the child in the tent and notify the health care provider.
• B. Increase the oxygen concentration in the tent.
• C. Take the child out of the tent and into the playroom.
• D. Ask the mother for help in comforting the child.

Correct answer: B

Rationale: The child with LTB should be placed in the mist tent with 30% oxygen. Restlessness is caused by poor oxygenation. The child should not be taken out of the oxygenated tent. While the mother could be asked to help comfort the child, and the health care provider may be notified, the priority is to set the oxygen at the correct level.

2. What could suddenly occur in a child with acute epiglottitis?

• A. Increased carbon dioxide levels
• B. Airway obstruction
• C. Inability to swallow
• D. Bronchial collapse

Correct answer: B

Rationale: In acute epiglottitis, the infected epiglottis becomes inflamed and can lead to sudden airway obstruction, which is a life-threatening emergency. This can cause difficulty breathing and necessitates immediate intervention to secure the airway. Increased carbon dioxide levels may occur due to inadequate ventilation resulting from airway obstruction, but the primary concern is the obstruction itself, not the carbon dioxide levels. Inability to swallow may be present due to pain and swelling in the throat but is not the immediate life-threatening complication associated with acute epiglottitis. Bronchial collapse is not a typical consequence of acute epiglottitis.

3. Which signs/symptoms would be considered classical signs of meningeal irritation?

• A. Positive Kernig sign, diarrhea, and headache
• B. Negative Brudzinski sign, positive Kernig sign, and irritability
• C. Positive Brudzinski sign, positive Kernig sign, and photophobia
• D. Negative Kernig sign, vomiting, and fever

Correct answer: C

Rationale: The correct answer is C: Positive Brudzinski sign, positive Kernig sign, and photophobia are considered classical signs of meningeal irritation. The Kernig sign is positive when the leg is extended at the knee and then raised, resulting in pain and resistance. The Brudzinski sign is positive when flexing the neck causes flexion of the hips and knees due to meningeal irritation. Photophobia, or sensitivity to light, is a common symptom due to meningeal inflammation. Choices A, B, and D are incorrect because they do not include the classic signs associated with meningeal irritation.

4. A client is currently receiving an infusion labeled as 5% dextrose injection 500 ml with heparin sodium 25,000 units at 14 mL/hour per pump. A prescription is received to change the rate of the infusion to heparin 1,000 units/hour. How many ml/hour should the nurse program the infusion pump?

• A. 16 ml/hour.
• B. 18 ml/hour.
• C. 20 ml/hour.
• D. 22 ml/hour.

Correct answer: C

Rationale: To deliver 1,000 units/hour from a solution with 25,000 units in 500 ml, the rate should be set to 20 ml/hour. This is calculated by determining that the solution has 50 units/ml (25,000 units / 500 ml = 50 units/ml) and then dividing the required 1,000 units/hour by 50 units/ml, resulting in 20 ml/hour. Therefore, the nurse should program the infusion pump to deliver heparin at 20 ml/hour. Choices A, B, and D are incorrect as they do not align with the calculated rate of 20 ml/hour.

5. What should be included in the medical management of sickle cell crisis?

• A. Information for the parents including home care
• B. Provisions for adequate hydration and pain management
• C. Pain management and administration of iron supplements
• D. Adequate oxygenation and factor VIII

Correct answer: B

Rationale: The correct answer is B: Provisions for adequate hydration and pain management. In managing a sickle cell crisis, it is essential to provide adequate hydration to prevent further sickling of red blood cells and ensure proper pain management to alleviate the severe pain associated with the crisis. While information for parents and home care may be important aspects of overall care, they are not specific to the immediate medical management of a sickle cell crisis. Administration of iron supplements is not recommended during a sickle cell crisis as it can potentially worsen the condition by promoting the production of more sickled red blood cells. Adequate oxygenation is crucial in sickle cell disease, but factor VIII is not typically part of the management of a sickle cell crisis.

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