Nursing Elites

1. What should the nurse include in the discharge teaching for a 3-year-old child diagnosed with acute otitis media?

• A. Encourage the child to drink plenty of fluids
• B. Encourage the child to eat a balanced diet
• C. Administer pain medication as needed
• D. Apply warm compresses to the affected ear

Correct answer: A

Rationale: The correct answer is to encourage the child to drink plenty of fluids. This helps to relieve symptoms and prevent dehydration in children with acute otitis media. Encouraging a balanced diet is important for overall health but may not directly impact otitis media symptoms. While administering pain medication as needed can help manage discomfort, it is not a primary discharge teaching for this condition. Applying warm compresses to the affected ear is not typically recommended in acute otitis media cases as it can potentially worsen the infection.

2. Why should the nurse closely monitor the IV flow rate for a 5-month-old infant with severe diarrhea receiving IV fluids?

• A. Maintaining electrolyte balance
• B. Preventing dehydration
• C. Preventing fluid overload
• D. Avoiding cardiac overload

Correct answer: C

Rationale: In infants, monitoring IV flow rates is essential to prevent fluid overload, not cardiac overload. Excessive fluid administration can lead to complications such as pulmonary edema or congestive heart failure. It is crucial to maintain a balance between providing adequate hydration and avoiding fluid overload to prevent adverse outcomes. Options A, B, and D are incorrect because the primary concern is to prevent complications related to excess fluid rather than focusing on electrolyte balance, dehydration prevention, or avoiding cardiac overload.

3. A 2-week-old infant is admitted with a tentative diagnosis of a ventricular septal defect. The parents report that their baby has had difficulty feeding since coming home after birth. What should the nurse consider before responding?

• A. Feeding problems are common in neonates.
• B. Inadequate sucking is not significant unless cyanosis is present.
• C. Ineffective sucking and swallowing may be early indications of a heart defect.
• D. Many neonates retain mucus, which can interfere with feeding for several weeks.

Correct answer: C

Rationale: Ineffective sucking and swallowing can be early signs of a heart defect like a ventricular septal defect. This is crucial information for the nurse to consider as it aligns with the infant's tentative diagnosis. Choice A is too general and does not provide specific relevance to the situation. Choice B is incorrect as inadequate sucking can indeed be significant, especially in the context of a potential heart defect. Choice D is not directly related to the potential heart defect and feeding difficulties mentioned in the scenario.

4. A 3-year-old child with a history of frequent respiratory infections is being evaluated for cystic fibrosis. What diagnostic test should the nurse anticipate will be ordered?

• A. Chest X-ray
• B. Sweat chloride test
• C. Pulmonary function test
• D. Sputum culture

Correct answer: B

Rationale: The sweat chloride test is the gold standard diagnostic test for cystic fibrosis as it measures the concentration of chloride in sweat. In cystic fibrosis, there is an abnormal transport of chloride across epithelial membranes, leading to elevated sweat chloride levels. A chest X-ray may show characteristic changes in the lungs associated with cystic fibrosis, but it is not a definitive diagnostic test. Pulmonary function tests assess lung function but do not specifically diagnose cystic fibrosis. Sputum culture may identify respiratory infections but does not confirm the diagnosis of cystic fibrosis.

5. A nurse is teaching the parents of a child with a diagnosis of type 1 diabetes mellitus about blood glucose monitoring. What should the nurse emphasize?

• A. Checking blood glucose levels before meals and at bedtime
• B. Using a lancet device to obtain blood samples
• C. Using urine test strips for monitoring
• D. Recognizing signs of hypoglycemia

Correct answer: A

Rationale: Checking blood glucose levels before meals and at bedtime is essential in managing type 1 diabetes mellitus as it helps in monitoring blood sugar levels at different times of the day and adjusting insulin doses accordingly. Option B about using a lancet device to obtain blood samples is a technique rather than an emphasis on monitoring frequency. Option C suggesting the use of urine test strips is incorrect as urine test strips are not recommended for accurate real-time monitoring of blood glucose levels in type 1 diabetes. Option D, recognizing signs of hypoglycemia, is important but not the primary emphasis when educating about blood glucose monitoring.

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