Nursing Elites

1. A 9-year-old child is brought to the clinic with complaints of fatigue, pallor, and shortness of breath. The nurse notes that the child has a history of iron-deficiency anemia. What is the nurse’s priority action?

• A. Administer iron supplements as prescribed
• B. Monitor the child’s hemoglobin levels
• C. Educate the parents about dietary sources of iron
• D. Notify the healthcare provider

Correct answer: A

Rationale: In a child with a history of iron-deficiency anemia presenting with symptoms of fatigue, pallor, and shortness of breath, the priority action for the nurse is to administer iron supplements as prescribed. Iron supplementation is essential to treat iron-deficiency anemia and improve the child's symptoms promptly. Monitoring hemoglobin levels is important but administering iron supplements takes precedence to address the underlying cause. Educating parents about dietary iron sources is valuable for prevention but not the immediate priority. Notifying the healthcare provider may be necessary but should not delay the initiation of treatment with iron supplements.

2. A child who is admitted to the hospital with anemia is anxious, fearful, and hyperventilating. The nurse anticipates the child developing which acid-base imbalance?

• A. Metabolic acidosis
• B. Respiratory acidosis
• C. Respiratory alkalosis
• D. Metabolic alkalosis

Correct answer: C

Rationale: In this scenario, the child is hyperventilating, which leads to excessive loss of carbon dioxide. This loss of carbon dioxide causes respiratory alkalosis due to a decrease in the partial pressure of carbon dioxide in the blood. Therefore, the correct answer is respiratory alkalosis. Choices A, B, and D are incorrect. Metabolic acidosis is characterized by a decrease in pH and bicarbonate levels due to conditions like kidney disease. Respiratory acidosis is caused by retention of carbon dioxide, leading to an increase in the partial pressure of carbon dioxide. Metabolic alkalosis results from a loss of acid or an increase in bicarbonate levels.

3. A 3-year-old child is brought to the clinic by the parents who are concerned that the child is not yet potty trained. What is the nurse’s best response?

• A. Most children are potty trained by this age, so you should not be concerned
• B. Every child develops at their own pace. Let’s discuss some strategies to help
• C. Your child may need to be evaluated for developmental delays
• D. It’s best to force your child to use the potty to encourage training

Correct answer: B

Rationale: The correct answer is B because it is important to acknowledge that children develop at different rates. By offering support and discussing strategies for potty training, the nurse can provide the necessary guidance without causing unnecessary concern or pressure on the parents. Choice A is incorrect because it dismisses the parents' concerns. Choice C is incorrect because jumping to the conclusion of developmental delays without further assessment or discussion can cause undue anxiety. Choice D is incorrect because forcing a child to use the potty can lead to resistance and negative associations with potty training.

4. A 4-year-old child is brought to the clinic with complaints of ear pain and fever. The practical nurse suspects otitis media. Which symptom supports this suspicion?

• A. Clear nasal discharge.
• B. Dry, hacking cough.
• C. Tugging at the ear.
• D. Sore throat.

Correct answer: C

Rationale: Tugging at the ear is a common symptom in children with otitis media. It often indicates discomfort or pain in the ear, suggesting inflammation or infection in the middle ear. This behavior is frequently observed in young children who are unable to express their discomfort verbally, making it a significant clinical indicator for otitis media in this age group. Clear nasal discharge (Choice A) is more indicative of a cold or allergies, while a dry, hacking cough (Choice B) is not typically associated with otitis media. Although a sore throat (Choice D) can sometimes accompany ear infections, tugging at the ear is a more specific and reliable symptom in this case.

5. A 2-year-old child with heart failure (HF) is admitted for replacement of a graft for coarctation of the aorta. Prior to administering the next dose of digoxin (Lanoxin), the nurse obtains an apical heart rate of 128 bpm. What action should the nurse take?

• A. Determine the pulse deficit.
• B. Administer the scheduled dose.
• C. Calculate the safe dose range.
• D. Review the serum digoxin level.

Correct answer: B

Rationale: Administering the scheduled dose is appropriate in this scenario since the heart rate of 128 bpm is within an acceptable range for a 2-year-old child with heart failure. Monitoring for signs of digoxin toxicity is important; however, the immediate action required is to administer the scheduled dose as prescribed based on the heart rate assessment.

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