Nursing Elites

1. A 3-year-old child is admitted to the hospital with a diagnosis of Kawasaki disease. What is the priority nursing intervention?

• A. Administering IV immunoglobulin
• B. Monitoring for coronary artery aneurysms
• C. Encouraging fluid intake
• D. Providing nutritional support

Correct answer: B

Rationale: The priority nursing intervention for a 3-year-old child with Kawasaki disease is monitoring for coronary artery aneurysms. Kawasaki disease can lead to the development of coronary artery aneurysms, which are one of the most serious complications of the disease. Early detection and monitoring of coronary artery changes are essential for prompt intervention and prevention of adverse outcomes. Administering IV immunoglobulin is an important treatment for Kawasaki disease, but monitoring for coronary artery aneurysms takes precedence as it directly impacts the child's long-term prognosis. Encouraging fluid intake and providing nutritional support are important aspects of care but are not the priority when compared to monitoring for potential life-threatening complications.

2. A parent calls the outpatient clinic requesting information about the appropriate dose of acetaminophen for a 16-month-old child who has signs of an upper respiratory tract infection and fever. The directions on the bottle of acetaminophen elixir are 120 mg every 4 hours when needed. At the toddler’s 15-month visit, the health care provider prescribed 150 mg. What is the nurse’s best response to the parent?

• A. “The dose is close enough, and it doesn’t really matter which one is given.”
• B. “From your description, the medications are not necessary. They should be avoided at this age.”
• C. “It is appropriate to use dosages based on age. Children typically have weights consistent for their age groups.”
• D. “The prescribed dose of the drug was based on weight, and this is a more accurate way of determining a therapeutic dose.”

Correct answer: D

Rationale: The most accurate way to determine a therapeutic dose for children is based on their weight rather than age. Weight-based dosing helps ensure that the child receives the appropriate amount of medication for their body size, which is crucial for safety and effectiveness. Age-based dosing can lead to underdosing or overdosing, as children of the same age can have significantly different weights. Choice A is incorrect because even small variations in dosages can have significant effects on a child's health. Choice B is incorrect as acetaminophen can be appropriate when used correctly for fever management in children. Choice C is incorrect as children's weights can vary greatly within the same age group, making weight-based dosing more precise and individualized.

3. A 2-year-old child with a diagnosis of hemophilia is admitted to the hospital. What should the nurse include in the care plan?

• A. Encourage participation in contact sports
• B. Use a soft toothbrush for oral care
• C. Administer nonsteroidal anti-inflammatory drugs
• D. Administer aspirin for pain

Correct answer: B

Rationale: The correct answer is to use a soft toothbrush for oral care. Children with hemophilia have a decreased ability to form blood clots, leading to prolonged bleeding. Using a soft toothbrush helps prevent trauma to the gums and oral mucosa, reducing the risk of bleeding. Encouraging participation in contact sports (Choice A) is contraindicated in hemophiliac patients due to the high risk of injury and bleeding. Administering nonsteroidal anti-inflammatory drugs (Choice C) and aspirin (Choice D) should be avoided in hemophilia as they can further increase the risk of bleeding due to their antiplatelet effects.

4. When assessing a child with suspected nephrotic syndrome, what clinical manifestation is the nurse likely to observe?

• A. Jaundice
• B. Edema
• C. Hypertension
• D. Polyuria

Correct answer: B

Rationale: Edema is a hallmark clinical manifestation of nephrotic syndrome. In nephrotic syndrome, there is increased glomerular permeability leading to the loss of proteins, particularly albumin, in the urine. This results in decreased oncotic pressure, leading to fluid shifting into the interstitial spaces and causing edema. Jaundice (Choice A) is not a typical clinical manifestation of nephrotic syndrome. Hypertension (Choice C) is more commonly associated with conditions like glomerulonephritis. Polyuria (Choice D) is not a primary symptom of nephrotic syndrome; instead, patients may have reduced urine output due to fluid retention from edema.

5. A healthcare provider is assessing a child with suspected pneumonia. What clinical manifestation is the healthcare provider likely to observe?

• A. Cough
• B. Diarrhea
• C. Rash
• D. Vomiting

Correct answer: A

Rationale: When assessing a child with suspected pneumonia, a healthcare provider is likely to observe a cough as a common clinical manifestation. Pneumonia often presents with symptoms such as cough, fever, difficulty breathing, and chest pain. Choice B, diarrhea, is not typically associated with pneumonia. Choice C, rash, is not a common clinical manifestation of pneumonia. Choice D, vomiting, is also not a typical symptom of pneumonia. Therefore, the correct answer is A: Cough.

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