Nursing Elites

1. A nurse in an emergency department is caring for a school-age child who is experiencing an anaphylactic reaction. Which of the following is the priority action by the nurse?

• A. Elevate the head of the child's bed
• B. Insert a large-bore IV catheter for the child
• C. Determine the allergen that caused the child's reaction
• D. Administer IM epinephrine to the child

Correct answer: D

Rationale: In the management of anaphylaxis, the priority action for the nurse is to administer IM epinephrine to the child. Epinephrine is the first-line treatment for anaphylaxis as it helps reverse the severe manifestations of the reaction by constricting blood vessels, relaxing airway muscles, and decreasing hives and swelling. Elevating the head of the child's bed may be beneficial for respiratory distress but is not the priority over administering epinephrine. Inserting a large-bore IV catheter may be necessary for fluid resuscitation but is not the initial priority. Identifying the allergen is important for prevention and future management but is not the immediate action needed in the acute phase of an anaphylactic reaction.

2. During a vaso-occlusive crisis in sickle cell anemia, what action is crucial for a nurse to take?

• A. Administer meperidine for pain.
• B. Apply cold compresses to the child's joints.
• C. Limit the child's fluid intake.
• D. Maintain bed rest for the child.

Correct answer: D

Rationale: During a vaso-occlusive crisis in sickle cell anemia, maintaining bed rest is crucial to reduce oxygen consumption and alleviate pain. Movement can worsen the crisis by increasing sickling of red blood cells, leading to further tissue damage and pain. Bed rest helps to improve blood flow, reduce pain, and promote healing. Administering meperidine for pain (Choice A) is not recommended due to the risk of normeperidine accumulation and potential neurotoxicity. Applying cold compresses (Choice B) may cause vasoconstriction, worsening the vaso-occlusive crisis. Limiting fluid intake (Choice C) is not appropriate as adequate hydration is essential to prevent dehydration and maintain blood flow.

3. During a developmental screening, a 4-year-old child is asked to perform a task. Which of the following tasks should the nurse expect the child to perform?

• A. Draw a stick figure with seven body parts
• B. Draw a circle
• C. Identify right from left hand
• D. Tie their shoelaces

Correct answer: B

Rationale: At 4 years old, children are typically able to draw a circle, which is a developmental milestone for their age. Drawing a stick figure with specific body parts might be beyond their developmental level, identifying right from left hand can be challenging, and tying shoelaces requires more advanced motor skills.

4. A nurse is teaching a parent of a child who has asthma. Which of the following instructions should the nurse include?

• A. Use a peak flow meter daily.
• B. Administer the medication with meals.
• C. Provide a low-carbohydrate diet.
• D. Limit exposure to cold air.

Correct answer: A

Rationale: The nurse should instruct the parent to use a peak flow meter daily to monitor the child�s respiratory status and detect early signs of an asthma attack.

5. A toddler in the emergency department has partial thickness burns on his right arm. Which of the following actions should the nurse take?

• A. Insert a nasogastric tube
• B. Initiate prophylactic antibiotic therapy
• C. Cleanse the affected area with mild soap and water
• D. Apply a topical corticosteroid to the affected area

Correct answer: C

Rationale: When a toddler has partial thickness burns, the nurse should cleanse the affected area with mild soap and water. This action helps remove any loose tissue that could lead to infection and prepares the area for appropriate wound care. Inserting a nasogastric tube (Choice A) is not indicated for a toddler with burns. Initiating prophylactic antibiotic therapy (Choice B) is not necessary for partial thickness burns unless there are signs of infection. Applying a topical corticosteroid (Choice D) is not recommended for initial management of burns as it can delay wound healing.

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