Nursing Elites

1. A 6-year-old boy with bronchial asthma takes the beta-adrenergic agonist agent albuterol (Proventil). The child's mother tells the nurse that she uses this medication to open her son's airway when he is having trouble breathing. What is the nurse's best response?

• A. Recommend that the mother bring the child in for immediate evaluation
• B. Advise the mother that overuse of the drug may cause chronic bronchitis
• C. Assure the mother that she is using the medication correctly
• D. Confirm that the medication helps to reduce airway inflammation

Correct answer: C

Rationale: The nurse's priority is to reassure the mother that she is using albuterol correctly to open her son's airways during episodes of difficulty breathing. This reassurance helps build trust and ensures that the child receives the intended benefit of the medication. The answer choice recommending immediate evaluation (A) is not appropriate at this point as the mother is using the medication as prescribed. Advising about overuse causing chronic bronchitis (B) is incorrect and may cause unnecessary alarm. Confirming that the medication helps reduce airway inflammation (D) is not the best response because albuterol is a beta-adrenergic agonist used primarily for bronchodilation in acute asthma exacerbations, rather than for reducing inflammation.

2. 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.

3. The parents of a 5-year-old child, recently diagnosed with celiac disease, are being educated by the healthcare provider. Which statement by the parents indicates a need for further teaching?

• A. We need to avoid giving our child any foods that contain wheat, barley, or rye
• B. Our child can still eat oats as long as they are labeled gluten-free
• C. We should read food labels carefully to check for hidden sources of gluten
• D. It’s okay for our child to have small amounts of gluten occasionally

Correct answer: D

Rationale: The correct answer is D. Children with celiac disease must strictly adhere to a gluten-free diet. Even small amounts of gluten can cause harm by triggering an immune response that damages the intestines. It is crucial for parents to understand that allowing their child to have small amounts of gluten occasionally is not safe and can lead to complications. Therefore, further teaching is needed to emphasize the importance of complete avoidance of gluten-containing foods for a child with celiac disease. Choices A, B, and C demonstrate understanding of the need to avoid gluten-containing foods and hidden sources of gluten, which are essential in managing celiac disease. Choice D is incorrect as it suggests a lax approach to the child's diet, which can be harmful in the case of celiac disease.

4. A child with Graves' disease who is taking propranolol (Inderal) is seen in the clinic. The nurse should monitor the child for which therapeutic response?

• A. Increased weight gain
• B. Decreased heart rate
• C. Reduced headaches
• D. Diminished fatigue

Correct answer: B

Rationale: When a child with Graves' disease is prescribed propranolol (Inderal), the nurse should monitor for a decreased heart rate as a therapeutic response. Propranolol is a beta-blocker that acts to slow down the heart rate, which is beneficial in managing the symptoms of Graves' disease, such as tachycardia and other cardiovascular manifestations. Choices A, C, and D are incorrect because propranolol is not typically associated with increased weight gain, reduced headaches, or diminished fatigue as its primary therapeutic effect in this context.

5. The nurse is planning for a 5-month-old with gastroesophageal reflux disease whose weight has decreased by 3 ounces since the last clinic visit one month ago. To increase caloric intake and decrease vomiting, what instructions should the nurse provide this mother?

• A. Give small amounts of baby food with each feeding.
• B. Thicken formula with cereal for each feeding.
• C. Dilute the child's formula with equal parts of water.
• D. Offer 10% dextrose in water between most feedings.

Correct answer: B

Rationale: Thickening formula with cereal is a recommended intervention for infants with gastroesophageal reflux disease (GERD) to help reduce vomiting and increase caloric intake. This modification can help the infant keep the food down better, reducing reflux symptoms while providing adequate nutrition. Giving small amounts of baby food with each feeding (Choice A) is not recommended for a 5-month-old with GERD as it may exacerbate symptoms. Diluting the child's formula with equal parts of water (Choice C) can lead to inadequate nutrition and is not advisable. Offering 10% dextrose in water between most feedings (Choice D) is not appropriate for managing GERD in infants and does not address the underlying issue of reflux.

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