Nursing Elites

1. A parent calls the outpatient clinic requesting information about the appropriate dose of acetaminophen for a 16-month-old child who has signs of an upper respiratory tract infection and fever. The directions on the bottle of acetaminophen elixir are 120 mg every 4 hours when needed. At the toddler’s 15-month visit, the health care provider prescribed 150 mg. What is the nurse’s best response to the parent?

• A. “The dose is close enough, and it doesn’t really matter which one is given.”
• B. “From your description, the medications are not necessary. They should be avoided at this age.”
• C. “It is appropriate to use dosages based on age. Children typically have weights consistent for their age groups.”
• D. “The prescribed dose of the drug was based on weight, and this is a more accurate way of determining a therapeutic dose.”

Correct answer: D

Rationale: The most accurate way to determine a therapeutic dose for children is based on their weight rather than age. Weight-based dosing helps ensure that the child receives the appropriate amount of medication for their body size, which is crucial for safety and effectiveness. Age-based dosing can lead to underdosing or overdosing, as children of the same age can have significantly different weights. Choice A is incorrect because even small variations in dosages can have significant effects on a child's health. Choice B is incorrect as acetaminophen can be appropriate when used correctly for fever management in children. Choice C is incorrect as children's weights can vary greatly within the same age group, making weight-based dosing more precise and individualized.

2. When assessing a child with a possible fracture, what would be the most reliable indicator for the nurse to identify?

• A. Lack of spontaneous movement
• B. Point tenderness
• C. Bruising
• D. Inability to bear weight

Correct answer: B

Rationale: Point tenderness is the most reliable indicator of a possible fracture in a child. It refers to localized pain at a specific point, indicating a potential bone injury. Lack of spontaneous movement (Choice A) is non-specific and can be due to various reasons. Bruising (Choice C) may be present in fractures but is not as specific as point tenderness. Inability to bear weight (Choice D) can also be seen in fractures but may not always be present, making it less reliable compared to point tenderness.

3. The parents of a child who is scheduled for open-heart surgery ask why their child must be subjected to chest tubes after surgery. What should the nurse consider before responding in language the parents will understand?

• A. They will increase tidal volumes.
• B. Drainage of air and fluid will be facilitated.
• C. They will maintain positive intrapleural pressure.
• D. Pressure on the pericardium and chest wall will be regulated.

Correct answer: B

Rationale: Chest tubes are necessary after open-heart surgery to facilitate the drainage of air and fluid from the chest cavity. These tubes help prevent complications such as pneumothorax (accumulation of air in the pleural space) or cardiac tamponade (build-up of fluid in the pericardial sac), which can be serious postoperative issues. Options A, C, and D are incorrect because chest tubes are primarily used for draining purposes and not for increasing tidal volumes, maintaining positive intrapleural pressure, or regulating pressure on the pericardium and chest wall.

4. A child with a diagnosis of asthma is being evaluated for medication management. What is an important assessment for the nurse to perform?

• A. Assess the child's sleep patterns
• B. Assess the child's dietary intake
• C. Assess the child's academic performance
• D. Assess the child's behavior at home

Correct answer: B

Rationale: Assessing the child's dietary intake is crucial in managing asthma as certain foods can trigger symptoms or exacerbate the condition. By evaluating the child's diet, the nurse can identify potential triggers, ensure the child receives proper nutrition, and help manage symptoms effectively. Assessing sleep patterns, academic performance, or behavior at home, while important in a holistic assessment, are not as directly related to managing asthma symptoms as dietary intake.

5. A parent calls the clinic because their child has ingested a small amount of household bleach. What should the nurse advise?

• A. Administer activated charcoal
• B. Induce vomiting immediately
• C. Call the poison control center
• D. Take the child to the emergency department

Correct answer: C

Rationale: The correct answer is to advise the parent to call the poison control center. When a child ingests household bleach, it is important to seek guidance from professionals who can provide specific and immediate advice on managing the situation. Administering activated charcoal (Choice A) is not recommended for household bleach ingestion. Inducing vomiting immediately (Choice B) can lead to further complications and is not the recommended first response. Taking the child to the emergency department (Choice D) should be done based on the advice received from the poison control center.

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