Nursing Elites

1. A child with newly diagnosed leukemia is receiving chemotherapy. Which would be included in his plan of care by the nurse?

• A. Place the child in a negative pressure isolation room
• B. Administer prophylactic IV antibiotics
• C. Avoid high protein food intake
• D. Teach family and visitors handwashing techniques

Correct answer: D

Rationale: The correct answer is to teach family and visitors handwashing techniques. Any client on chemotherapy should have good infection control measures in place, such as handwashing by all who they encounter. Placing the child in a negative pressure isolation room (Choice A) is not necessary unless specifically indicated for a certain condition. Administering prophylactic IV antibiotics (Choice B) may not be part of the standard care plan for a child with leukemia receiving chemotherapy. Avoiding high protein food intake (Choice C) is not directly related to infection control and may not be necessary unless there are specific dietary restrictions.

2. A woman is in the active phase of labor. An external monitor has been applied, and a fetal heart deceleration of uniform shape is observed, beginning just as the contraction is underway and returning to the baseline at the end of the contraction. Which of the following nursing actions is most appropriate?

• A. Administer O2 if necessary.
• B. Turn the client on her left side.
• C. Notify the physician.
• D. No action is necessary.

Correct answer: D

Rationale: The correct answer is 'No action is necessary.' In this scenario, the fetal heart deceleration of uniform shape observed is an early deceleration resulting from head compression. Early decelerations are benign and typically do not require any intervention as they mirror the contraction pattern. It is essential to closely observe both the mother and the baby. Administering O2 (Choice A) is not necessary as early decelerations do not indicate fetal distress. Turning the client on her left side (Choice B) is not required for early decelerations. Notifying the physician (Choice C) is not needed for this type of deceleration, as it is a normal response to head compression during labor.

3. What are the side effects of first-generation over-the-counter (OTC) antihistamines like diphenhydramine (Benadryl) and hydroxyzine (Atarax) in infants and children?

• A. Reye's syndrome.
• B. cholinergic effects.
• C. paradoxical CNS stimulation.
• D. nausea and diarrhea.

Correct answer: C

Rationale: The correct answer is paradoxical CNS stimulation. First-generation OTC antihistamines, such as diphenhydramine and hydroxyzine, can lead to paradoxical CNS stimulation in infants and children. This phenomenon is characterized by symptoms like excitement, euphoria, restlessness, and confusion, rather than the expected sedative effect. Due to this unexpected response, these antihistamines are used less frequently in pediatric populations. Reye's syndrome is a rare systemic response to a virus and is not a side effect of antihistamines. First-generation OTC antihistamines do not typically exhibit cholinergic effects. Nausea and diarrhea are uncommon side effects of these antihistamines and are less commonly observed than paradoxical CNS stimulation.

4. When dressing a severe burn to the right hand, it is important for the nurse to:

• A. Apply a wet-to-dry dressing for debridement
• B. Wrap each digit individually to prevent webbing
• C. Open blisters to allow drainage prior to dressing
• D. Allow the client to do as much of the dressing change as possible

Correct answer: B

Rationale: When dressing a severe burn to the hand, it is crucial to wrap each digit individually to prevent webbing, which can lead to contractures and impaired function. Applying a wet-to-dry dressing for debridement is not recommended for burn wounds as it can cause trauma to the wound bed during removal. Opening blisters can increase the risk of infection and delay healing. Allowing the client to perform the dressing change may not ensure proper care and can lead to complications.

5. The test used to differentiate sickle cell trait from sickle cell disease is:

• A. Sickle cell preparation.
• B. Peripheral smear.
• C. Sickledex.
• D. Hemoglobin electrophoresis

Correct answer: D

Rationale: The correct test to differentiate between sickle cell trait and sickle cell disease is hemoglobin electrophoresis. This test separates different types of hemoglobin based on their electrical charge, allowing for the identification of specific hemoglobin variants like HbS in sickle cell disease. Sickle cell preparation and Sickledex are not specific tests for this differentiation. While a peripheral smear can show sickle cells, it does not provide a definitive differentiation between the trait and the disease as it doesn't identify the specific hemoglobin variant present.

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