Nursing Elites

1. What intervention should the nurse implement first for a male toddler brought to the emergency center approximately three hours after swallowing tablets from his grandmother's bottle of digoxin (Lanoxin)?

• A. Administer activated charcoal
• B. Prepare gastric lavage
• C. Obtain a 12-lead electrocardiogram
• D. Give IV digoxin immune fab (Digibind)

Correct answer: A

Rationale: Administering activated charcoal is the priority intervention as it binds with digoxin, preventing further absorption in the gastrointestinal tract. This helps reduce the amount of digoxin available for systemic circulation and minimizes its toxic effects. Gastric lavage is no longer recommended due to potential complications and lack of evidence of efficacy. Obtaining an electrocardiogram may help assess the effects of digoxin toxicity, but it is not the initial priority. IV digoxin immune fab (Digibind) is used in severe cases of digoxin toxicity but is not the first-line intervention.

2. Which developmental behavior should the practical nurse identify as normal for a 6-month-old infant?

• A. Rolls over completely.
• B. Creeps on all fours.
• C. Pulls self to a standing position.
• D. Assumes a sitting position independently.

Correct answer: A

Rationale: The correct answer is A: 'Rolls over completely.' By 6 months of age, infants typically achieve the milestone of rolling over completely. This ability demonstrates increasing strength and coordination. Creeping on all fours, pulling self to a standing position, and assuming a sitting position independently are skills that are usually developed at later stages of infancy. Creeping usually occurs around 9-10 months, pulling self to a standing position around 9-12 months, and assuming a sitting position independently around 8 months. Therefore, at 6 months, rolling over completely is the most expected developmental behavior.

3. The mother of a 4-month-old asks the nurse for advice in preventing diaper rash. What suggestion should the nurse provide?

• A. At diaper change generously powder the baby's diaper area with talcum powder to promote dryness.
• B. Wash the diaper area every 2 hours with soap and water to help prevent skin breakdown.
• C. Use a barrier cream, such as zinc oxide, which does not have to be completely removed with each diaper change.
• D. Place a cloth diaper inside the disposable diaper for overnight periods when increased wearing time is likely.

Correct answer: C

Rationale: Using a barrier cream like zinc oxide protects the skin and helps prevent diaper rash.

4. When caring for a 5-year-old child with a history of seizures who suddenly begins to have a tonic-clonic seizure, what should the nurse do first?

• A. Administer oxygen
• B. Insert an oral airway
• C. Turn the child to the side
• D. Start an IV line

Correct answer: C

Rationale: During a tonic-clonic seizure, the priority action is to turn the child to the side. This helps maintain an open airway and prevents aspiration of secretions or vomitus. It also helps in keeping the airway clear and promotes safety during the seizure episode. Administering oxygen, inserting an oral airway, and starting an IV line are important interventions but should follow the initial step of positioning the child to prevent airway obstruction.

5. A 2-year-old child with respiratory syncytial virus (RSV) is being treated in the hospital. What should the healthcare provider monitor for in this child?

• A. Increased urine output.
• B. Decreased respiratory rate.
• C. Labored breathing.
• D. Improved appetite.

Correct answer: C

Rationale: Labored breathing is a critical sign of worsening respiratory distress in children with RSV. It indicates that the child's condition may be deteriorating, requiring prompt intervention to ensure adequate oxygenation and prevent respiratory failure. Monitoring for labored breathing allows healthcare providers to promptly assess and manage the child's respiratory status, potentially preventing further complications associated with RSV infection.

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