Nursing Elites

1. A child with a diagnosis of leukemia is admitted to the hospital with a fever. What is the priority nursing intervention?

• A. Administering antibiotics
• B. Administering antipyretics
• C. Providing nutritional support
• D. Monitoring for signs of infection

Correct answer: D

Rationale: The correct answer is D: Monitoring for signs of infection. When a child with leukemia presents with a fever, the priority nursing intervention is to monitor for signs of infection due to the immunocompromised state of the child. Administering antibiotics (choice A) may be necessary based on the assessment of signs of infection, but monitoring comes first. Administering antipyretics (choice B) helps to reduce fever but does not address the underlying cause. Providing nutritional support (choice C) is essential but not the priority when the child is at risk of infection.

2. At 0345, you receive a call for a woman in labor. Upon arriving at the scene, you are greeted by a very anxious man who tells you that his wife is having her baby 'now.' This man escorts you into the living room where a 25-year-old woman is lying on the couch in obvious pain. The woman states that her contractions are occurring every 4 to 5 minutes and lasting approximately 30 seconds each. Which of the following questions would be most appropriate to ask at this point?

• A. Has your bag of waters broken yet?
• B. Have you had regular prenatal care?
• C. At how many weeks gestation are you?
• D. How many other children do you have?

Correct answer: C

Rationale: Asking about the gestational age is crucial in determining the stage of labor and assessing potential complications. This information helps in understanding the progress of labor and making appropriate decisions regarding the management of the delivery process. Choices A, B, and D are not as pertinent at this point in providing immediate care or assessing the situation compared to knowing the gestational age.

3. Why is it recommended that closure of the palate should be done before the age of 2 for an 11-month-old infant with a cleft palate?

• A. “After the age of 2, surgery becomes frightening and should be avoided if possible.”
• B. “The eruption of the 2-year molars often complicates the surgical procedure.”
• C. “As your child grows older, the palate widens, making repair more challenging.”
• D. “Surgery should be performed before your child begins to use faulty speech patterns.”

Correct answer: D

Rationale: It is recommended to perform palate closure surgery before the child starts using faulty speech patterns to prevent the development of speech issues that may be harder to correct later. Delaying surgery until after the age of 2 can lead to the child forming incorrect speech habits, which can be challenging to correct. Choices A, B, and C are incorrect because they do not address the specific concern related to speech development in children with cleft palates.

4. A child sitting on a chair in a playroom starts to have a tonic-clonic seizure with a clenched jaw. What is the nurse’s best initial action?

• A. Attempt to open the jaw.
• B. Place the child on the floor.
• C. Call out for assistance from staff.
• D. Place a pillow under the child’s head.

Correct answer: B

Rationale: The correct initial action during a tonic-clonic seizure is to place the child on the floor to prevent injury. This action helps protect the child from falling off the chair and provides a safer environment for the seizure to occur. Attempting to open the jaw can cause harm or injury. Calling out for assistance is important but should follow the immediate action of moving the child to the floor. Placing a pillow under the child’s head is not recommended as it may lead to airway obstruction or further injury during the seizure.

5. A child with a diagnosis of nephrotic syndrome is being treated with corticosteroids. What is an important nursing consideration?

• A. Monitor for signs of infection
• B. Monitor blood pressure
• C. Monitor for hyperglycemia
• D. Monitor for hypertension

Correct answer: A

Rationale: When a child with nephrotic syndrome is undergoing treatment with corticosteroids, it is crucial to monitor for signs of infection. Corticosteroids can suppress the immune system, increasing the child's susceptibility to infections. Monitoring for signs of infection allows for early detection and prompt intervention. While monitoring blood pressure, hyperglycemia, and hypertension are important considerations in certain conditions and treatments, they are not the primary concern when a child with nephrotic syndrome is on corticosteroid therapy.

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