Nursing Elites

1. When teaching a school-age child and the parent how to administer insulin, which of the following instructions should the nurse include?

• A. Store the insulin in the refrigerator after each use.
• B. Rotate injection sites each time you give the injection.
• C. You should give the insulin at room temperature.
• D. Administer the insulin within 30 minutes of each meal.

Correct answer: C

Rationale: It is essential to give insulin at room temperature to prevent discomfort during administration. Cold insulin can cause stinging and pain, which can be avoided by allowing the insulin to reach room temperature before administration. Storing insulin in the refrigerator is correct for long-term storage, but it should be brought to room temperature before use. Rotating injection sites is important to prevent lipohypertrophy, a condition characterized by fatty lumps that can develop if injections are consistently given in the same area. Administering insulin within 30 minutes of a meal is generally recommended to match the insulin peak action with the peak glucose levels after eating, but giving insulin at room temperature is more crucial to ensure comfort and proper absorption.

2. The nurse is planning care for a school-age client who is postoperative for the surgical removal of the appendix. In addition to pharmacologic pain management, what should the nurse include in the plan of care to address pain?

• A. Applying a warm, moist pack every 4 hours
• B. Applying EMLA cream to the incision site prior to ambulation
• C. Applying a cold, moist pack every 2 hours
• D. Applying a pillow against the abdomen to splint the incision site when coughing

Correct answer: D

Rationale: After an appendectomy, applying a pillow against the abdomen to splint the incision site when coughing helps reduce pain by providing support and minimizing movement that could cause discomfort.

3. A child is being assessed for possible appendicitis with perforation. Which of the following findings should the nurse expect?

• A. Hyperactive bowel sounds
• B. Abdominal distension
• C. Hypoactive bowel sounds
• D. Bradycardia

Correct answer: D

Rationale: In a child with appendicitis and possible perforation, the nurse should expect bradycardia due to peritoneal irritation. Bradycardia is a common response to peritoneal inflammation or infection, indicating a possible serious complication. Hyperactive bowel sounds, abdominal distension, and hypoactive bowel sounds are more commonly associated with other gastrointestinal conditions and are less likely to be present in a child with appendicitis and perforation. Therefore, the correct answer is bradycardia (D) as it aligns with the expected physiological response in this scenario.

4. What will the nurse caution the parents of a child who has had a nephrectomy that he will have to avoid?

• A. Contact sports
• B. Horseback riding
• C. Alcohol
• D. Diuretic medications

Correct answer: A

Rationale: Children who have only one kidney should avoid contact sports to prevent injury to that remaining organ.

5. During an assessment, which manifestation should a healthcare provider expect in an infant with pyloric stenosis?

• A. Bile-stained vomitus
• B. Distended abdomen
• C. Olive-shaped mass in the upper abdomen
• D. Painless, swollen joints

Correct answer: C

Rationale: Pyloric stenosis in infants typically presents with an olive-shaped mass in the upper abdomen due to hypertrophy of the pyloric muscle. This mass can often be palpated during an assessment and is a key characteristic of this condition. Bile-stained vomitus may be seen in conditions such as intestinal obstruction; a distended abdomen can be a nonspecific sign of various conditions, and painless, swollen joints are not typically associated with pyloric stenosis.

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