Nursing Elites

1. A child admitted with diabetic ketoacidosis is demonstrating Kussmaul respirations. The nurse determines that the increased respiratory rate is a compensatory mechanism for which acid-base alteration?

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

Correct answer: D

Rationale: Kussmaul respirations are deep, rapid breathing patterns observed in metabolic acidosis, such as diabetic ketoacidosis. In this condition, the body tries to compensate for the acidic environment by increasing the respiratory rate to eliminate excess carbon dioxide (CO2) and decrease the acid levels, thereby helping to correct the acid-base imbalance. Therefore, the correct answer is metabolic acidosis.

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. A child with a fever of 39°C (102.2°F) and a sore throat is brought to the clinic. The practical nurse suspects the child has streptococcal pharyngitis. Which diagnostic test should the practical nurse prepare the child for?

• A. Rapid antigen detection test.
• B. Throat culture.
• C. Complete blood count (CBC).
• D. Chest X-ray.

Correct answer: A

Rationale: A rapid antigen detection test is the appropriate diagnostic test for suspected streptococcal pharyngitis. This test is commonly used due to its quick results, helping in the prompt diagnosis and appropriate treatment of the condition. It specifically detects the presence of streptococcal antigens in the throat, aiding in confirming the diagnosis and guiding the healthcare provider in determining the most suitable treatment plan. Throat culture (Choice B) is a confirmatory test but is not as rapid as the rapid antigen detection test. Complete blood count (Choice C) and Chest X-ray (Choice D) are not specific tests for streptococcal pharyngitis and would not aid in confirming the diagnosis.

4. Why is honest information important in building a trusting relationship with adolescent patients?

• A. Encourage the adolescent to seek help outside of the school clinic.
• B. Keep disclosures from the adolescent confidential.
• C. Honest information ensures establishing a trusting relationship.
• D. Discourage minor adolescents from disclosing private concerns.

Correct answer: C

Rationale: Honesty is fundamental in building trust with adolescent patients as it helps create an environment where they feel safe to share their concerns openly. By being honest and maintaining confidentiality, healthcare providers can establish a strong and trusting relationship with adolescents, ultimately leading to better healthcare outcomes.

5. A mother brings her 3-week-old infant to the clinic because the baby vomits after eating and always seems hungry. Further assessment indicates that the infant’s vomiting is projectile, and the child seems listless. Which additional assessment finding indicates the possibility of a life-threatening complication?

• A. Irregular palpable pulse
• B. Hyperactive bowel sounds
• C. Underweight for age
• D. Crying without tears

Correct answer: D

Rationale: In this scenario, the infant presenting with vomiting, lethargy, and projectile vomiting indicates a potential serious condition. Crying without tears is a sign of dehydration, a critical condition that can lead to life-threatening complications in infants. Dehydration can rapidly worsen an infant's condition, making prompt intervention crucial to prevent further complications. Irregular palpable pulse (Choice A) could indicate a cardiovascular issue but is less immediately life-threatening in this context. Hyperactive bowel sounds (Choice B) are more indicative of gastrointestinal issues rather than a life-threatening complication. Underweight for age (Choice C) may be concerning for growth-related issues but does not directly indicate a life-threatening complication like dehydration does.

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