Nursing Elites

1. During a primary survey of a child with partial thickness burns over the upper body areas, what action should the nurse take first?

• A. Inspect the child's skin color.
• B. Assess for a patent airway.
• C. Observe for symmetric breathing.
• D. Palpate the child's pulse.

Correct answer: B

Rationale: When managing a child with partial thickness burns over the upper body areas, the priority action during the primary survey is to assess for a patent airway. This step is crucial as burns in this region can lead to airway compromise, potentially causing rapid deterioration in the child's condition. Checking for a patent airway ensures that the child can breathe adequately, which is essential for oxygenation and ventilation. Inspecting the child's skin color (Choice A) is an important assessment but should follow ensuring a patent airway. Observing for symmetric breathing (Choice C) is relevant, but the immediate focus should be on securing the airway. Palpating the child's pulse (Choice D) is also a vital assessment, but in this scenario, the priority is to assess and maintain a clear airway to support respiratory function and oxygen delivery.

2. A child has been admitted to the pediatric unit with a severe asthma attack. What type of acid-base imbalance should the nurse expect the child to develop?

• A. metabolic alkalosis due to insufficient production of acid metabolites
• B. respiratory alkalosis due to depressed respirations and retention of carbon dioxide
• C. respiratory acidosis due to impaired respirations and increased formation of carbonic acid
• D. metabolic acidosis due to the kidneys' inability to compensate for decreased carbonic acid formation

Correct answer: C

Rationale: In a severe asthma attack, the child is likely to develop respiratory acidosis. This occurs due to impaired respirations, leading to the retention of carbon dioxide and the formation of carbonic acid. Choice A is incorrect as metabolic alkalosis is not expected in this situation. Choice B is incorrect as respiratory alkalosis does not align with the scenario of impaired respirations in severe asthma attacks. Choice D is also incorrect as it describes metabolic acidosis, which is not typically associated with severe asthma attacks.

3. A child with diabetes insipidus is being treated with vasopressin. The nurse would assess the child closely for signs and symptoms of which condition?

• A. Syndrome of inappropriate antidiuretic hormone (SIADH)
• B. Thyroid storm
• C. Cushing syndrome
• D. Vitamin D toxicity

Correct answer: A

Rationale: When a child with diabetes insipidus is treated with vasopressin, the nurse should closely monitor for signs and symptoms of Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Vasopressin, also known as antidiuretic hormone, helps retain water in the body. Excessive vasopressin administration can lead to water retention, dilutional hyponatremia, and potentially result in SIADH. Choices B, C, and D are incorrect because they are not directly associated with the use of vasopressin in treating diabetes insipidus.

4. The school nurse is caring for a boy with hemophilia who fell on his arm during recess. What supportive measures should the nurse use until factor replacement therapy can be instituted?

• A. Apply warm, moist compresses
• B. Apply pressure for at least 1 minute
• C. Elevate the area above the level of the heart
• D. Begin passive range-of-motion unless the pain is severe

Correct answer: C

Rationale: The correct supportive measure for the school nurse to use for a boy with hemophilia who fell on his arm during recess is to elevate the area above the level of the heart. Elevating the affected area helps reduce bleeding and swelling in a child with hemophilia until factor replacement therapy can be provided. Applying warm, moist compresses (Choice A) may worsen bleeding by dilating blood vessels. Applying pressure for at least 1 minute (Choice B) is not recommended for hemophilia as it can lead to increased bleeding. Beginning passive range-of-motion (Choice D) should be avoided as it can exacerbate bleeding and further injury in a child with hemophilia.

5. When developing the plan of care for a child with cerebral palsy, which treatment would the nurse expect as least likely?

• A. Skeletal traction
• B. Physical therapy
• C. Orthotics
• D. Occupational therapy

Correct answer: A

Rationale: In caring for a child with cerebral palsy, skeletal traction is least likely to be a part of the treatment plan. Cerebral palsy is a neurological disorder affecting movement and muscle coordination, and skeletal traction, which involves applying a pulling force on a bone to correct alignment, is not a common intervention for this condition. Physical therapy, orthotics, and occupational therapy are more commonly used in the management of cerebral palsy. Physical therapy helps improve mobility and strength, orthotics assist in supporting and aligning the body, and occupational therapy focuses on enhancing daily living skills and independence. Therefore, skeletal traction is the least likely treatment option among the choices provided.

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