Nursing Elites

1. A pediatric client is admitted to the emergency department with a traumatic brain injury (TBI) that caused a loss of consciousness. The last set of vital signs showed heart rate 48, blood pressure (BP) 148/74 mmHg, respiratory rate 28 and irregular. What does the nurse suspect based on these data?

• A. Spinal cord injury
• B. Increased intracranial pressure
• C. Typical for sleep
• D. Improvement

Correct answer: B

Rationale: The vital signs of bradycardia, hypertension, and irregular respirations indicate increased intracranial pressure. Bradycardia (heart rate of 48), hypertension (blood pressure of 148/74 mmHg), and irregular respirations are typical signs of increased intracranial pressure in a pediatric client with a traumatic brain injury and loss of consciousness.

2. When developing a home program for self-care, which approach is the most effective?

• A. Require the parent to practice the steps regularly and track progress.
• B. Introduce new home programs weekly with clear instructions for the parent to follow.
• C. List all the steps and have the parent teach them to the child without practicing.
• D. Practice the new steps until the child is ready to independently perform them at home.

Correct answer: D

Rationale: The most effective approach when developing a home program for self-care is to practice the new steps with the child until they are capable of independently carrying them out at home. This method ensures that the child has mastered the skills before transitioning to independent implementation. It is essential for the child's success in self-care activities and promotes their autonomy and confidence. Requiring the parent to practice the steps regularly and track progress, introducing new programs weekly, or having the parent teach the steps without practice may not be as beneficial in fostering the child's independence and skill acquisition.

3. When preparing to insert an intravenous catheter for a 7-year-old child, which of the following actions should a healthcare professional take?

• A. Apply an anesthetic cream to the insertion site 1 hr before the procedure.
• B. Use a 16-gauge needle for the insertion.
• C. Insert the catheter into a vein of the child's dominant hand.
• D. Choose a site over the child's metacarpal veins.

Correct answer: A

Rationale: Applying an anesthetic cream to the insertion site 1 hr before the procedure is crucial when inserting an intravenous catheter in a child to minimize pain and discomfort during the procedure. This practice is especially important in pediatric patients to ensure a more comfortable experience and improve cooperation during the insertion process. Choice B is incorrect as a 16-gauge needle is too large for a child, and a smaller gauge needle is typically used. Choice C is incorrect as the catheter should be inserted into a suitable vein, not specifically the dominant hand vein. Choice D is incorrect as metacarpal veins are usually avoided due to their small size and the potential for complications.

4. When providing teaching to the family of a school-age child with juvenile idiopathic arthritis, which instruction should the nurse include?

• A. Limit the child's movement of the large joints.
• B. Encourage the child to perform independent self-care.
• C. Provide the child with a soft mattress for sleeping.
• D. Schedule a 2-hour daily nap for the child in the afternoon.

Correct answer: B

Rationale: Encouraging the child to perform independent self-care is essential when managing juvenile idiopathic arthritis. This instruction helps minimize pain and stiffness in the child's joints while promoting mobility and independence. It is crucial for the child to learn self-management skills early to cope better with the condition in the long term.

5. The nurse is reviewing the prescriber�s orders and notes that omeprazole has been order for a patient admitted with acute coronary syndrome (ACS). The nurse should be concerned if this medication is combined with which medication noted on the patient�s record.

• A. Aspirin 81mg daily
• B. Clopidogrel (Plavix) 75mg daily
• C. Heparin 5000 units subQ q12hrs
• D. Metoprolol 50mg q8hrs

Correct answer: B

Rationale: For patients who lack risk factors for GI bleeding, combined use of clopidogrel with a PPI, may reduce the effects of clopidogrel without offering any real benefits and thus should be avoided.

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