Nursing Elites

1. A parent and 4-year-old child who recently emigrated from Colombia arrive at the pediatric clinic. The child has a temperature of 102°F, is irritable, and has a runny nose. Inspection reveals a rash and several small, red, irregularly shaped spots with blue-white centers in the mouth. What illness does the nurse suspect the child has?

• A. Measles
• B. Chickenpox
• C. Fifth disease
• D. Scarlet fever

Correct answer: A

Rationale: The nurse should suspect measles based on the symptoms described, including the presence of Koplik spots (small, red spots with blue-white centers in the mouth). Measles typically presents with fever, irritability, runny nose, and a rash that begins on the face and spreads downward. Chickenpox (choice B) presents with vesicular lesions in different stages of healing and usually starts on the trunk. Fifth disease (choice C) presents with a 'slapped cheek' rash on the face and can cause joint pain. Scarlet fever (choice D) is characterized by a sandpaper-like rash, fever, and strawberry tongue.

2. A child with juvenile idiopathic arthritis (JIA) is under the care of a nurse. What is the priority nursing intervention?

• A. Encouraging a diet high in protein
• B. Administering nonsteroidal anti-inflammatory drugs (NSAIDs)
• C. Applying heat to affected joints
• D. Providing range-of-motion exercises

Correct answer: B

Rationale: The priority nursing intervention for a child with juvenile idiopathic arthritis (JIA) is administering nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation. NSAIDs are commonly used in the treatment of JIA to help alleviate symptoms. While encouraging a diet high in protein, applying heat to affected joints, and providing range-of-motion exercises are essential components of care, addressing pain and inflammation with NSAIDs is the priority intervention. This is because controlling pain and inflammation is crucial in improving the child's comfort and quality of life, which takes precedence over other supportive measures.

3. A child with a diagnosis of asthma is being cared for by a nurse. What is an important nursing intervention?

• A. Administering bronchodilators
• B. Encouraging physical activity
• C. Monitoring oxygen saturation
• D. Providing nutritional support

Correct answer: A

Rationale: Administering bronchodilators is a crucial nursing intervention for a child with asthma because it helps to open the airways and ease breathing during an asthma attack. Bronchodilators are medications that work by relaxing the muscles around the airways, making it easier for the child to breathe. Encouraging physical activity may exacerbate asthma symptoms in some cases due to increased respiratory effort and exposure to triggers. Monitoring oxygen saturation is important but does not address the immediate need of opening the airways during an asthma episode. Providing nutritional support is essential for overall health but is not the primary intervention needed in managing an acute asthma exacerbation.

4. The caregiver is caring for an infant with osteogenesis imperfecta and is providing instruction on how to reduce the risk of injury. Which response from the caregiver indicates a need for further teaching?

• A. I need to avoid pushing or pulling on an arm or leg.
• B. I should carefully lift the baby by supporting the head and neck.
• C. I should not bend an arm or leg into an awkward position.
• D. We must avoid lifting the legs by the ankles to change diapers.

Correct answer: B

Rationale: Lifting the baby by supporting the head and neck can cause fractures in infants with osteogenesis imperfecta. Caregivers should avoid lifting infants in this manner due to the risk of injury. Choices A, C, and D demonstrate correct understanding of how to prevent injuries in infants with osteogenesis imperfecta by avoiding excessive force on the arms or legs, preventing awkward positions, and lifting the legs in a safer manner to change diapers.

5. When administering IV fluids to a dehydrated infant, what intervention is most important at this time?

• A. Continuing the prescribed flow rate
• B. Monitoring the intravenous drop rate
• C. Calculating the total necessary intake
• D. Maintaining the fluid at body temperature

Correct answer: B

Rationale: Monitoring the intravenous drop rate is crucial when administering IV fluids to ensure that the correct amount of fluids is delivered to the dehydrated infant. Choice A assumes the initial rate is correct without ongoing assessment. Choice C, while important, does not address the immediate need for monitoring the infusion rate. Choice D, maintaining the fluid at body temperature, is essential for comfort but is not as critical as ensuring the correct fluid delivery rate. By monitoring the intravenous drop rate, healthcare providers can adjust the flow as needed to prevent overhydration or underhydration, helping to manage the infant's fluid balance effectively.

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