Nursing Elites

1. 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.

2. The healthcare provider finds a 6-month-old infant unresponsive and calls for help. After opening the airway and finding the infant is still not breathing, which action should the provider take?

• A. Palpate femoral pulse and check for regularity.
• B. Deliver cycles of 30 chest compressions and 2 breaths.
• C. Give two breaths that make the chest rise.
• D. Feel the carotid pulse and check for adequate breathing.

Correct answer: C

Rationale: In pediatric basic life support, for an unresponsive infant who is not breathing normally, the correct action is to give two breaths that make the chest rise. This helps provide oxygen to the infant's body and is a crucial step in resuscitation efforts for infants in distress. Choices A, B, and D are incorrect. Palpating the femoral pulse or feeling the carotid pulse is not indicated in this scenario where the infant is unresponsive and not breathing. Delivering cycles of chest compressions and breaths is not the immediate action to take; the priority is to provide two breaths to help with oxygenation.

3. The nurse is caring for a 3-year-old child who has been recently diagnosed with cystic fibrosis. Which discharge instruction by the nurse is most important to promote pulmonary function?

• A. Chest physiotherapy should be performed before meals and at bedtime
• B. Cough suppressants can be used up to four times a day for relief
• C. Oxygen should be given through a nasal cannula between 4-6 L/min
• D. Exercise is discouraged in order to preserve pulmonary vital capacity

Correct answer: B

Rationale: In cystic fibrosis, thick mucus obstructs the airways, making it difficult to clear from the lungs. Cough suppressants can help reduce the discomfort associated with persistent coughing, allowing the child to cough more effectively to clear the mucus, thus promoting pulmonary function. Chest physiotherapy, not exercise, helps mobilize the mucus. Oxygen therapy may be needed but is not the most important for promoting pulmonary function in this case.

4. According to Erikson's theory, what behavioral pattern should be displayed by a child who has not developed a sense of competence?

• A. Guilt.
• B. Shame.
• C. Alienation.
• D. Inferiority.

Correct answer: D

Rationale: Erikson's theory of psychosocial development outlines that the failure to establish a sense of competence during the industry vs. inferiority stage results in feelings of inferiority. This stage occurs during middle childhood where children strive to master skills and tasks. If they are unable to meet challenges successfully, they may start feeling inferior to their peers and may lack confidence in their abilities. Choices A, B, and C are incorrect as guilt, shame, and alienation are not the specific behavioral patterns associated with the lack of developing a sense of competence according to Erikson's theory.

5. A child diagnosed with Kawasaki disease is brought to the clinic. The mother reports that her child is irritable, refuses to eat, and has skin peeling on both hands and feet. Which intervention should the nurse instruct the mother to implement first?

• A. Place the child in a quiet environment
• B. Make a list of foods that the child likes
• C. Encourage the parents to rest when possible
• D. Apply lotion to hands and feet

Correct answer: A

Rationale: Creating a quiet environment is the priority intervention as it helps reduce irritability and stress in children with Kawasaki disease. This intervention can promote a soothing atmosphere for the child, which may help in managing their symptoms effectively. Irritability and refusal to eat can be exacerbated by a noisy or stimulating environment. Making a list of foods the child likes is important, but addressing the immediate need for a calm environment takes precedence. Encouraging parents to rest is a good practice but not the immediate intervention needed for the child's symptoms. Applying lotion to hands and feet, although helpful for skin peeling, is not the first priority when dealing with irritability and refusal to eat.

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