Nursing Elites

1. A 4-month-old girl is brought to the clinic by her mother because she has had a cold for 2 to 3 days and woke up this morning with a hacking cough and difficulty breathing. Which additional assessment finding should alert the nurse that the child is in acute respiratory distress?

• A. Bilateral bronchial breath sounds.
• B. Diaphragmatic respiration.
• C. A resting respiratory rate of 35 breaths per minute.
• D. Flaring of the nares.

Correct answer: D

Rationale: Flaring of the nares is a clinical sign of acute respiratory distress in infants. It indicates an increased effort to breathe and is a crucial finding that requires immediate attention, as it signifies the child is having difficulty breathing and may be in respiratory distress. Choices A, B, and C are incorrect. Bilateral bronchial breath sounds may be present in conditions like pneumonia but do not specifically indicate acute respiratory distress. Diaphragmatic respiration is a normal breathing pattern and not a sign of distress. A resting respiratory rate of 35 breaths per minute in a 4-month-old infant is within the expected range, so it does not necessarily indicate acute respiratory distress.

2. The healthcare provider is preparing to administer a scheduled dose of digoxin to a 4-year-old child with heart failure. The healthcare provider notes that the child’s heart rate is 70 beats per minute. What should the healthcare provider do next?

• A. Administer the medication as prescribed
• B. Hold the medication and notify the healthcare provider
• C. Recheck the heart rate in 30 minutes
• D. Administer half of the prescribed dose

Correct answer: B

Rationale: In pediatric patients, digoxin administration is guided by the heart rate. If the child's heart rate is below the established threshold, which is typically 90-100 beats per minute in a 4-year-old, the medication should be withheld, and the healthcare provider should be notified for further evaluation and instructions. Choice A is incorrect because administering the medication when the heart rate is low can lead to adverse effects. Rechecking the heart rate in 30 minutes (Choice C) may delay necessary intervention if the heart rate remains low. Administering half of the prescribed dose (Choice D) is not recommended without healthcare provider guidance.

3. A 7-year-old child with type 1 diabetes is brought to the emergency department with abdominal pain, nausea, and vomiting. The nurse notes that the child's blood glucose level is 350 mg/dL. What should the nurse do first?

• A. Administer IV fluids as prescribed
• B. Administer insulin as prescribed
• C. Monitor the child's urine output
• D. Check the child's urine for ketones

Correct answer: A

Rationale: In a child with type 1 diabetes presenting with abdominal pain, nausea, vomiting, and a high blood glucose level, the priority is to administer IV fluids to correct dehydration and electrolyte imbalances, which are crucial in managing diabetic ketoacidosis. Administering insulin without addressing fluid deficits can lead to further complications. While monitoring urine output and checking for ketones are important steps in the care of a child with diabetes, the immediate focus should be on correcting dehydration and electrolyte imbalances through IV fluid administration to stabilize the child's condition.

4. A 15-year-old client with type 1 diabetes presents to the clinic for a routine follow-up. The nurse notes that the client’s hemoglobin A1c is 10%. What should the nurse include in the plan of care?

• A. Increase the frequency of self-monitoring of blood glucose.
• B. Discuss dietary changes to reduce carbohydrate intake.
• C. Review the client’s insulin administration technique.
• D. All of the above

Correct answer: D

Rationale: A hemoglobin A1c of 10% indicates poor blood glucose control, reflecting an average blood sugar level over the past 2-3 months. To improve control, the plan of care should be comprehensive. Increasing the frequency of self-monitoring of blood glucose helps track changes in blood sugar levels. Discussing dietary changes to reduce carbohydrate intake can aid in better blood sugar management. Reviewing the client’s insulin administration technique ensures proper medication dosing. Therefore, all the options (increasing monitoring, discussing dietary changes, and reviewing insulin administration) are essential components of the plan of care to address the client's poor blood glucose control. The correct answer is D because all these interventions are crucial for managing the client's condition effectively. Choices A, B, and C individually address different aspects of diabetes management and are all necessary in this scenario.

5. The parents of a 9-month-old infant are being educated about preventing iron deficiency anemia. Which statement by the parent indicates a correct understanding of the teaching?

• A. I will start giving my baby whole cow’s milk at 12 months
• B. I will give my baby iron-fortified cereal
• C. I will give my baby fruit juice between meals
• D. I will give my baby water with meals

Correct answer: B

Rationale: The correct answer is B: 'I will give my baby iron-fortified cereal.' Iron-fortified cereal is an excellent source of iron for infants, aiding in the prevention of iron deficiency anemia. Choice A is incorrect as whole cow’s milk should not be introduced until the child is at least 12 months old to prevent iron deficiency. Choice C is incorrect because giving fruit juice between meals can interfere with iron absorption. Choice D is incorrect as giving water with meals can decrease nutrient intake. Therefore, the best choice to prevent iron deficiency anemia in a 9-month-old infant is to give them iron-fortified cereal.

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