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. A child who has just had definitive repair of a high rectal malformation is to be discharged. What should the nurse address in the discharge preparation of this family?

• A. Safe administration of daily enemas
• B. Necessity of firm stools to keep suture line clean
• C. Bowel training beginning as soon as the child returns home
• D. Changes in stooling patterns to report to the practitioner

Correct answer: D

Rationale: Postoperative care should focus on monitoring changes in stooling patterns, which could indicate complications such as stenosis or obstruction. It is crucial to educate the family on the importance of promptly reporting any changes in stooling patterns to the healthcare provider. Options A and B are not recommended unless specifically ordered by the physician as they can potentially cause harm or discomfort postoperatively. Option C may not be appropriate immediately after surgery and should be guided by the healthcare provider's recommendations.

3. When caring for a child with an intravenous (IV) infusion, what is an appropriate nursing action?

• A. Change the insertion site every 24 hours.
• B. Check the insertion site frequently for signs of infiltration.
• C. Use a macrodropper to facilitate reaching the prescribed flow rate.
• D. Avoid restraining the child to prevent undue emotional stress.

Correct answer: B

Rationale: Frequent monitoring of the IV site for signs of infiltration is crucial to prevent tissue damage, especially in pediatric patients. Changing the site every 24 hours is unnecessary unless complications arise, and using a macrodropper is not specific to pediatric care.

4. Which parental statement indicates correct understanding of information presented regarding the prevention of iron deficiency anemia in infants?

• A. "We will add green leafy vegetables to our child’s low-iron formula."
• B. "We will discontinue the use of vitamin C supplements by 6 months of age."
• C. "We will begin an iron-fortified infant cereal at 4 to 6 months of age."
• D. "We will introduce cow’s milk by 6 months of age."

Correct answer: C

Rationale: The correct answer is C. Introducing iron-fortified cereal between 4 to 6 months of age is a recommended practice to prevent iron deficiency anemia in infants. Iron-fortified infant cereals are a good source of iron for infants. Choices A and B are incorrect because adding green leafy vegetables to low-iron formula and discontinuing vitamin C supplements do not directly address the prevention of iron deficiency anemia. Choice D is incorrect because cow's milk should be avoided before 12 months of age as it is low in iron and can lead to intestinal blood loss, increasing the risk of iron deficiency anemia.

5. What recommendation should the nurse make to prevent urinary tract infections (UTIs) in young girls?

• A. Avoid public toilet facilities
• B. Limit long baths as much as possible
• C. Cleanse the perineum with water after voiding
• D. Ensure clear liquid intake of 2 L/day

Correct answer: C

Rationale: Proper perineal hygiene, including cleansing with water after voiding, is crucial in preventing UTIs in young girls. Avoiding public toilets and limiting baths are less effective than proper hygiene practices.

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