Nursing Elites

1. A 5-year-old child is brought to the emergency department with severe abdominal pain and vomiting. The child’s parent reports that the pain started suddenly and is located in the lower right abdomen. What should the nurse do first?

• A. Administer pain medication
• B. Notify the healthcare provider immediately
• C. Start an IV line for fluid administration
• D. Obtain a complete blood count

Correct answer: B

Rationale: The correct answer is to notify the healthcare provider immediately. The child's presentation of sudden, severe abdominal pain in the lower right abdomen is highly concerning for appendicitis, a medical emergency. Promptly notifying the healthcare provider is crucial for further evaluation and management. Administering pain medication as the first action might mask symptoms and delay diagnosis. Starting an IV line for fluid administration and obtaining a complete blood count are important interventions but should come after healthcare provider notification.

2. What should the nurse do first for a 6-year-old with asthma showing a prolonged expiratory phase, wheezing, and 35% of personal best peak expiratory flow rate (PEFR)?

• A. Administer a prescribed bronchodilator.
• B. Encourage the child to cough and take deep breaths.
• C. Report the findings to the healthcare provider.
• D. Identify the triggers that precipitated this attack.

Correct answer: A

Rationale: Administering a bronchodilator is the priority action in managing an acute asthma exacerbation in a child. Bronchodilators help to relax the muscles around the airways, opening them up and improving breathing. This intervention aims to address the immediate breathing difficulty and should be done promptly to provide relief for the child. Encouraging coughing and deep breaths (choice B) may worsen the child's condition by further constricting the airways. Reporting findings to the healthcare provider (choice C) is important but not the immediate priority in this acute situation. Identifying triggers (choice D) is crucial for long-term asthma management but is not the first step when managing an acute exacerbation.

3. A male infant with bronchiolitis is brought to the clinic by his mother. The infant is congested and febrile with a capillary refill of 2 seconds. Which information should the nurse discuss with the mother?

• A. Encourage the infant to play
• B. Limit the amount of oral intake
• C. Keep the infant isolated from others
• D. Place the infant on their back for naps

Correct answer: C

Rationale: Bronchiolitis is a highly contagious respiratory infection commonly caused by viruses. Isolating the infant from others is crucial to prevent the spread of the infection to other vulnerable individuals, especially those with weakened immune systems. Encouraging play may not be appropriate as the infant is sick and needs rest. Limiting oral intake might be necessary if the infant is having difficulty swallowing due to respiratory distress. Placing the infant on their back for naps is a safe sleep practice but not the priority in this situation where preventing transmission of the infection is crucial.

4. When a 3-year-old boy asks a nurse why his baby sister is eating his mommy’s breast, how should the nurse respond? (Select the response that does not apply.)

• A. Remind him that his mother breastfed him too
• B. Clarify that breastfeeding is the mother’s choice
• C. Reassure the older brother that it does not hurt his mother
• D. Explain that newborns get milk from their mothers in this way

Correct answer: A

Rationale: In this scenario, the nurse should avoid reminding the older sibling about his own breastfeeding experience as it does not directly address the question posed by the boy. Providing simple explanations about breastfeeding and newborn feeding patterns helps the older sibling understand the natural process without bringing up personal experiences. Choice B is correct because clarifying that breastfeeding is the mother's choice helps the older sibling understand the concept of personal decisions. Choice C is appropriate as reassuring the older brother that it does not hurt his mother addresses a common concern children may have. Choice D is also suitable as it explains in simple terms how newborns receive milk from their mothers.

5. A male adolescent who is newly diagnosed with a seizure disorder receives a prescription for an anticonvulsant. Which statement indicates the client is at risk for non-compliance with life-long medication management?

• A. I hope I will be able to drive while taking these pills.
• B. My friends will think I am a freak if I take these pills.
• C. I don't want my parents monitoring my medications.
• D. I will take the pills at home so others will not see me.

Correct answer: B

Rationale: The statement 'My friends will think I am a freak if I take these pills' indicates concerns about peer perception, which can lead to non-compliance in adolescents. Peer pressure and fear of social stigma can significantly impact medication adherence in this age group. Option B is the most concerning response as it reflects the client's worry about how others perceive him for taking medication, potentially leading to non-compliance due to social pressures. Choices A, C, and D do not directly address societal perception or peer pressure, making them less likely to impact the client's medication adherence negatively.

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