Nursing Elites

1. A child with cystic fibrosis is being discharged home with pancreatic enzyme replacement therapy. What information should the practical nurse reinforce with the parents?

• A. Give the enzymes after meals.
• B. Mix the enzymes with hot food or drinks.
• C. Enzymes should be taken before or with meals.
• D. Avoid giving enzymes with any food or drink.

Correct answer: C

Rationale: The correct answer is C: 'Enzymes should be taken before or with meals.' Pancreatic enzymes should be taken before or with meals to assist with digestion in children with cystic fibrosis. This timing helps maximize the effectiveness of the enzymes in breaking down nutrients from food. Giving the enzymes after meals (choice A) may not provide the necessary support for digestion. Mixing the enzymes with hot food or drinks (choice B) is not recommended as it may affect the enzymes' efficacy. Avoiding giving enzymes with any food or drink (choice D) is incorrect as enzymes need to be taken in conjunction with meals to aid in digestion.

2. The parents of a 10-year-old child with newly diagnosed type 1 diabetes are being taught by the nurse about managing their child’s condition. Which statement by the parents indicates they need further teaching?

• A. We should rotate injection sites to prevent tissue damage
• B. Our child should avoid all sugary foods and drinks
• C. We will monitor blood glucose levels regularly
• D. Our child needs to wear a medical alert bracelet

Correct answer: B

Rationale: It is important for individuals with diabetes to manage their carbohydrate intake, including sugary foods and drinks, rather than completely avoiding them. Sugary foods should be consumed in moderation as part of a balanced diet to help maintain stable blood glucose levels.

3. What is the priority intervention for a 16-year-old client with a history of depression who is brought to the emergency department after taking an overdose of acetaminophen?

• A. Administer activated charcoal
• B. Place the client on continuous cardiac monitoring
• C. Prepare for gastric lavage
• D. Administer N-acetylcysteine as prescribed

Correct answer: D

Rationale: The priority intervention for a client who has taken an acetaminophen overdose is to administer N-acetylcysteine promptly. N-acetylcysteine is the antidote for acetaminophen overdose and helps prevent liver damage. Activated charcoal may be used in certain cases, but N-acetylcysteine takes precedence as it directly counteracts the toxic effects of acetaminophen. Continuous cardiac monitoring and gastric lavage are not the priority interventions for acetaminophen overdose. Administering N-acetylcysteine is crucial to prevent liver damage and address the overdose, making it the most urgent action in this scenario.

4. A 3-year-old child is admitted to the hospital with severe dehydration. The healthcare provider prescribes an IV infusion of 0.9% normal saline. The nurse notes that the child’s heart rate is 150 beats per minute, and the blood pressure is 90/50 mm Hg. What should the nurse do first?

• A. Administer the IV fluids as prescribed
• B. Notify the healthcare provider
• C. Check the child’s urine output
• D. Reassess the child’s vital signs in 30 minutes

Correct answer: A

Rationale: In a pediatric patient with severe dehydration and signs of compromised hemodynamics such as tachycardia (heart rate of 150 bpm) and hypotension (blood pressure of 90/50 mm Hg), the priority intervention is to administer IV fluids as prescribed. Immediate fluid resuscitation is essential to restore hydration, improve perfusion, and stabilize the child's vital signs. While it's important to monitor urine output, initiating fluid resuscitation takes precedence in this situation. Notifying the healthcare provider can cause a delay in critical intervention, and waiting to reassess vital signs in 30 minutes can be detrimental in a child with severe dehydration and compromised hemodynamics.

5. During a well-baby check, the nurse hides a block under the baby's blanket, and the baby looks for the block. Which normal growth and development milestone is the baby developing?

• A. Separation anxiety.
• B. Associative play.
• C. Object prehension.
• D. Object permanence.

Correct answer: D

Rationale: When a baby looks for a hidden object, it demonstrates the development of object permanence. This milestone is significant as it signifies the baby's understanding that objects continue to exist even when they are not visible. It is a crucial aspect of cognitive development in infancy. Choice A, separation anxiety, refers to distress when separated from a primary caregiver and is not demonstrated in this scenario. Choice B, associative play, involves interactive play with others and is not relevant to object search. Choice C, object prehension, refers to the ability to grasp and hold objects, which is not specifically demonstrated by looking for a hidden object in this context.

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