Nursing Elites

1. A child who weighs 25 kg is receiving IV ampicillin at a dose of 300 mg/kg/24 hours in equally divided doses every 4 hours. How many milligrams should the nurse administer to the child for each dose?

• A. 1875 mg
• B. 625 mg
• C. 2000 mg
• D. 1500 mg

Correct answer: A

Rationale: To calculate the correct dose for each administration, you first need to find the total daily dose: 300 mg/kg * 25 kg = 7500 mg/day. Since this total dose is divided into equally divided doses every 4 hours, there are 6 doses in 24 hours. Therefore, 7500 mg ÷ 6 doses = 1250 mg per dose. The nurse should administer 1250 mg every 4 hours, resulting in a total of 1875 mg for each dose in a 24-hour period. Choice A, 1875 mg, is the correct answer. Choice B, 625 mg, is incorrect as it does not consider the total daily dose and the frequency of administration. Choice C, 2000 mg, is incorrect as it is not the calculated dosage based on the given parameters. Choice D, 1500 mg, is also incorrect as it does not reflect the correct dosage calculation for each dose.

2. A 7-year-old child is admitted to the hospital with nephrotic syndrome. The nurse notes that the child has gained 3 pounds in the past 24 hours. What should the nurse do first?

• A. Administer a diuretic as prescribed
• B. Restrict the child’s fluid intake
• C. Notify the healthcare provider
• D. Measure the child’s abdominal girth

Correct answer: C

Rationale: In a child with nephrotic syndrome experiencing sudden weight gain, the priority action for the nurse is to notify the healthcare provider. This weight gain could indicate worsening edema or fluid retention, necessitating immediate medical evaluation and intervention. The healthcare provider can conduct a comprehensive assessment, order necessary tests, and adjust the treatment plan accordingly. Administering a diuretic, restricting fluid intake, or measuring abdominal girth should not be initiated without healthcare provider consultation to ensure appropriate management of the child's condition.

3. 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.

4. The heart rate for a 3-year-old with a congenital heart defect has steadily decreased over the last few hours; it is now 76 bpm, whereas the previous reading 4 hours ago was 110 bpm. Which additional finding should be reported immediately to a healthcare provider?

• A. Oxygen saturation of 94%.
• B. Respiratory rate of 25 breaths/minute.
• C. Urine output of 20 mL/hr.
• D. Blood pressure of 70/40.

Correct answer: D

Rationale: A significant drop in heart rate and blood pressure should be reported immediately as it may indicate worsening of the congenital heart defect. A decrease in blood pressure to 70/40 is a critical finding that suggests potential cardiovascular compromise and requires urgent attention to prevent further deterioration. Oxygen saturation, respiratory rate, and urine output are important parameters, but in this scenario, the alarming decrease in blood pressure is a more critical finding that necessitates immediate reporting to the healthcare provider.

5. A 7-year-old child with type 1 diabetes is brought to the emergency department with abdominal pain, nausea, and vomiting. The nurse notes that the child's blood glucose level is 350 mg/dL. What should the nurse do first?

• A. Administer IV fluids as prescribed
• B. Administer insulin as prescribed
• C. Monitor the child's urine output
• D. Check the child's urine for ketones

Correct answer: A

Rationale: In a child with type 1 diabetes presenting with abdominal pain, nausea, vomiting, and a high blood glucose level, the priority is to administer IV fluids to correct dehydration and electrolyte imbalances, which are crucial in managing diabetic ketoacidosis. Administering insulin without addressing fluid deficits can lead to further complications. While monitoring urine output and checking for ketones are important steps in the care of a child with diabetes, the immediate focus should be on correcting dehydration and electrolyte imbalances through IV fluid administration to stabilize the child's condition.

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