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. What action should you take if a newborn's heart rate is 50 beats/min?

• A. Begin chest compressions.
• B. Reassess in 30 seconds.
• C. Administer blow-by oxygen.
• D. Start positive-pressure ventilations.

Correct answer: D

Rationale: If a newborn's heart rate is below 60 beats per minute, the appropriate action is to start positive-pressure ventilations. Ventilations help deliver oxygen to the newborn's body and support respiratory function, which is critical in cases of bradycardia. Chest compressions are not recommended until the heart rate is below 60 despite adequate ventilation. Reassessment is essential but not the immediate action required in this scenario. Administering blow-by oxygen alone may not effectively address the underlying cause of bradycardia, making positive-pressure ventilations the priority intervention in this case.

3. Seizures in children MOST often result from:

• A. a life-threatening infection.
• B. an inflammatory process in the brain.
• C. an abrupt rise in body temperature.
• D. a temperature greater than 102°F.

Correct answer: C

Rationale: Seizures in children most often result from febrile seizures, which are triggered by an abrupt rise in body temperature. Febrile seizures are common in young children, especially between the ages of 6 months to 5 years, and are usually associated with viral infections that cause a sudden spike in body temperature. Choices A, B, and D are incorrect because while infections, inflammatory processes, and high temperatures can sometimes lead to seizures, the most common cause of seizures in children is an abrupt increase in body temperature, known as febrile seizures.

4. You are treating a 5-year-old child who has had severe diarrhea and vomiting for 3 days and is now showing signs of shock. Supplemental oxygen has been given, and you have elevated his lower extremities. En route to the hospital, you note that his work of breathing has increased. You should:

• A. begin positive-pressure ventilations and reassess the child.
• B. lower the extremities and reassess the child.
• C. listen to the lungs with a stethoscope for abnormal breath sounds.
• D. insert a nasopharyngeal airway and increase the oxygen flow.

Correct answer: B

Rationale: When the work of breathing increases after elevating the legs, it is important to lower the extremities. Elevating the lower extremities in a child with signs of shock can worsen the condition by reducing venous return to the heart. Lowering the extremities can help improve venous return and potentially alleviate the increased work of breathing.

5. How should the nurse prepare the sibling of a near-drowning accident victim who wants to see his brother in the pediatric intensive care unit, considering the child was present during the accident?

• A. Have the parents explain to the child why the sibling is so sick and inform the child that this could be the last time he sees his brother.
• B. Reassure the sibling not to cry in the child's room to avoid upsetting the ill child.
• C. If death is imminent, avoid informing the child about it and minimize involvement in care to protect the child from further trauma.
• D. Cover tubes and wires with a sheet, wash off any existing blood, and prepare him for what he will see.

Correct answer: D

Rationale: When preparing a sibling to see their brother in the pediatric intensive care unit after a near-drowning accident, it is essential to cover tubes and wires with a sheet, wash off any existing blood, and explain what the sibling will see. This approach helps the sibling understand the situation better and prepares them emotionally for the encounter, reducing potential distress and trauma. By providing information and visual preparation, the sibling can have a more controlled and less overwhelming experience when visiting their brother in the intensive care unit. Choice A is incorrect as informing the child that this could be the last time he sees his sibling may cause unnecessary distress and anxiety. Choice B is incorrect as it dismisses the sibling's emotional response, which is essential to address in a supportive manner. Choice C is incorrect as honesty and appropriate information sharing are crucial, even in difficult situations, to help the child cope effectively with the circumstances.

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