Nursing Elites

1. A school-age child is admitted to the pediatric unit with a vaso-occlusive crisis. Which of these should be included in the nursing plan of care?

• A. Correction of alkalosis
• B. Pain management and administration of heparin
• C. Adequate oxygenation and replacement of factor VIII to correct the sickling
• D. Adequate hydration, oxygenation, and pain management

Correct answer: D

Rationale: The correct answer is D. Vaso-occlusive crises in sickle cell anemia require a comprehensive approach that includes adequate hydration to reduce blood viscosity, oxygenation to prevent further sickling of red blood cells, and aggressive pain management. This approach helps improve tissue perfusion and manage pain effectively. Choices A, B, and C are incorrect. Correction of alkalosis is not a priority in vaso-occlusive crisis management. Administration of heparin is not indicated as it can increase the risk of bleeding in sickle cell patients. Factor VIII replacement is not relevant to sickle cell anemia as it is a treatment for hemophilia, not sickle cell disease.

2. The apnea monitor alarm sounds on a neonate for the third time during this shift. What is the priority action by the nurse?

• A. Provide tactile stimulation.
• B. Administer 100% oxygen.
• C. Investigate possible causes of a false alarm.
• D. Assess infant for color and presence of respirations.

Correct answer: D

Rationale: The priority action for the nurse when the apnea monitor alarm sounds on a neonate is to assess the infant for color and the presence of respirations. This initial assessment helps determine the infant's respiratory status and the need for immediate intervention. Providing tactile stimulation or administering oxygen should only be done after assessing the infant's respiratory status. Investigating possible causes of a false alarm comes after ensuring the infant's well-being through the initial assessment.

3. Why does the nurse have a 2-year-old boy sit in a “tailor” position while palpating for the presence of the testes?

• A. It prevents the cremasteric reflex
• B. Undescended testes can be palpated
• C. The child has an inguinal hernia
• D. The child does not yet have a need for privacy

Correct answer: A

Rationale: The tailor position stretches the muscle responsible for the cremasteric reflex, preventing it from contracting and pulling the testes into the pelvic cavity. This position helps accurately palpate the testes. Choice B is incorrect because the position does not facilitate the palpation of undescended testes specifically. Choice C is incorrect as it does not relate to the rationale behind the tailor position. Choice D is incorrect as the reason for using the tailor position is not related to the child's need for privacy.

4. When discussing discipline with the mother of a 4-year-old child, which should the nurse include?

• A. Parental control should be consistent.
• B. Withdrawal of love and approval is effective at this age.
• C. Children as young as 4 years rarely need to be disciplined.
• D. One should expect rules to be followed rigidly and unquestioningly.

Correct answer: A

Rationale: Consistent parental control is crucial for effective discipline, providing clear expectations and consequences for behavior.

5. For minimal change nephrotic syndrome (MCNS), prednisone is effective when what occurs?

• A. Appetite increases and blood pressure is normal
• B. Urinary tract infection is gone and edema subsides
• C. Generalized edema subsides and blood pressure is normal
• D. Diuresis occurs as urinary protein excretion diminishes

Correct answer: D

Rationale: The effectiveness of prednisone in treating MCNS is indicated by diuresis and a decrease in urinary protein excretion. Subsidence of generalized edema is also a positive sign, but the key indicator is the reduction in proteinuria, which is achieved through diuresis.

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