Nursing Elites

1. A child of 3 years has been admitted to your pediatric ward. The doctor gave a provisional diagnosis of respiratory tract infection. After careful assessment and history, he gave a final diagnosis of lower respiratory infection. Which of the following signs will confirm the diagnosis?

• A. Cough
• B. Fever
• C. Inability to lie supine
• D. Inability to eat

Correct answer: C

Rationale: Inability to lie supine is a specific sign of lower respiratory infection. This condition can cause discomfort or difficulty in breathing when lying flat, leading to a preference for an upright or semi-upright position. While cough and fever are common symptoms of respiratory infections, the inability to lie supine is more indicative of lower respiratory involvement.

2. A female child, age 2, is brought to the emergency department after ingesting an unknown number of aspirin tablets about 30 minutes earlier. Her father is blaming the mother for neglecting the child while she was cooking. On entering the examination room, the child is crying and clinging to the mother. Which data should the nurse obtain first?

• A. Heart rate, respiratory rate, and blood pressure
• B. Recent exposure to communicable diseases
• C. Number of immunizations received
• D. Height and weight

Correct answer: A

Rationale: In this scenario, the priority is to assess the child's vital signs first, including heart rate, respiratory rate, and blood pressure. These data will provide critical information on the child's current physiological status and guide further interventions. Option B, recent exposure to communicable diseases, is not the priority in an acute ingestion situation. Option C, number of immunizations received, and option D, height and weight, are important but not as critical as assessing vital signs in this immediate situation.

3. The healthcare provider is assessing a newborn who is 2 hours old. Which finding requires immediate intervention?

• A. Acrocyanosis
• B. Respiratory rate of 60 breaths per minute
• C. Grunting with nasal flaring
• D. Heart rate of 140 beats per minute

Correct answer: C

Rationale: Grunting with nasal flaring is a concerning sign of respiratory distress in a newborn that can indicate inadequate oxygenation. This finding requires immediate intervention to ensure the newborn's respiratory status is stabilized and to prevent further complications. Prompt assessment and appropriate intervention are crucial in such cases to prevent respiratory compromise and potential deterioration. Acrocyanosis, which is bluish discoloration of the extremities, is a common finding in newborns and usually resolves on its own. A respiratory rate of 60 breaths per minute and a heart rate of 140 beats per minute are within normal ranges for a newborn and do not indicate immediate intervention is needed.

4. You are dispatched to a residence where an 8-year-old boy was pulled from a swimming pool. When you arrive, a neighbor is performing rescue breathing on the child. After confirming that the child is not breathing, you should:

• A. begin chest compressions and reassess in 2 minutes.
• B. assess for a carotid pulse for no more than 10 seconds.
• C. tell the neighbor to continue rescue breathing as you apply the AED.
• D. ask the neighbor how long the child was submerged under the water.

Correct answer: B

Rationale: In cases of drowning, it is crucial to assess for a carotid pulse for no more than 10 seconds to determine if chest compressions are needed. This quick assessment helps determine the next steps in providing appropriate care to the patient. Performing chest compressions without confirming the need may not be beneficial and could potentially harm the patient if unnecessary.

5. When assessing a 6-year-old boy with pain in the right lower quadrant of his abdomen, which action should be performed first?

• A. Avoiding palpation of the abdomen.
• B. Palpating the right lower quadrant first.
• C. Auscultating bowel sounds for 2 minutes.
• D. Palpating the left upper quadrant first.

Correct answer: D

Rationale: Palpating the left upper quadrant first is the correct approach when assessing abdominal pain in a child. This method helps to minimize causing additional discomfort to the child and allows for a more accurate assessment of their reaction to palpation. By starting on the left upper quadrant, you can gauge the child's pain response before moving to the area of complaint, which may be more sensitive. This approach is essential for a thorough and less distressing abdominal assessment in pediatric patients.

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