Nursing Elites

1. A 7-year-old child is admitted to the hospital with nephrotic syndrome. The nurse notes that the child has gained 3 pounds in the past 24 hours. What should the nurse do first?

• A. Administer a diuretic as prescribed
• B. Restrict the child’s fluid intake
• C. Notify the healthcare provider
• D. Measure the child’s abdominal girth

Correct answer: C

Rationale: In a child with nephrotic syndrome experiencing sudden weight gain, the priority action for the nurse is to notify the healthcare provider. This weight gain could indicate worsening edema or fluid retention, necessitating immediate medical evaluation and intervention. The healthcare provider can conduct a comprehensive assessment, order necessary tests, and adjust the treatment plan accordingly. Administering a diuretic, restricting fluid intake, or measuring abdominal girth should not be initiated without healthcare provider consultation to ensure appropriate management of the child's condition.

2. When developing a behavior modification program for an extremely aggressive 10-year-old boy, what should the nurse do first?

• A. Determine what activities, foods, and toys the child enjoys
• B. Evaluate the child’s previous reactions to punishment
• C. Provide the child with positive feedback
• D. Encourage other children on the unit to describe the token system

Correct answer: A

Rationale: The first step in developing a behavior modification program for an aggressive child is to determine what activities, foods, and toys the child enjoys. Understanding the child's preferences allows the nurse to personalize the program, making it more engaging and effective. This approach increases the chances of success in modifying the aggressive behavior. Evaluating previous reactions to punishment (Choice B) may be important but comes later in the process. Providing positive feedback (Choice C) is beneficial but should come after tailoring the program. Encouraging other children to describe the token system (Choice D) is not the initial step; the focus should be on individualizing the program for the specific child first.

3. What is the most suitable toy for a 3-year-old boy receiving weekly chemotherapy treatment?

• A. Bouncy ball
• B. Coloring book with crayons
• C. Duck that squeaks
• D. Remote-controlled car

Correct answer: B

Rationale: A coloring book with crayons is the best choice as it is safe, engaging, and can provide a distraction during treatment without posing any safety risks. Coloring activities can help keep the child occupied, promote creativity, and offer a calming and therapeutic outlet during chemotherapy sessions.

4. A 7-year-old child with sickle cell anemia presents to the emergency department with severe pain in the arms and legs. What is the nurse’s priority action?

• A. Administer prescribed pain medication
• B. Apply warm compresses to the affected areas
• C. Encourage the child to drink fluids
• D. Monitor the child’s oxygen saturation

Correct answer: A

Rationale: In a sickle cell crisis, pain management is a priority due to the severe pain experienced by the child. Administering prescribed pain medication is crucial to alleviate the pain and provide comfort to the child. Once pain is controlled, other comfort measures like applying warm compresses and encouraging fluid intake can be implemented. Monitoring oxygen saturation is important but not the priority action when dealing with severe pain in a sickle cell crisis.

5. A mother brings her 3-month-old infant to the clinic because the baby does not sleep through the night. Which finding is most significant in planning care for this family?

• A. The mother is a single parent and lives with her parents
• B. The mother states the baby is irritable during feedings
• C. The infant’s formula has been changed twice
• D. The diaper area shows severe skin breakdown

Correct answer: D

Rationale: Severe skin breakdown in the diaper area is a significant finding indicating a potential health issue that needs immediate attention. It may be a sign of a skin condition, such as a diaper rash, which can cause discomfort and pain for the infant. Addressing this concern promptly is crucial to prevent further complications and ensure the baby's well-being. The other choices may also be important in assessing the overall situation of the family, but in terms of immediate care for the infant, the severe skin breakdown takes priority.

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