Nursing Elites

1. An intravenous line is needed in a school-age child. What medication is an appropriate analgesic for use with this patient?

• A. TAC (tetracaine, epinephrine [Adrenalin], cocaine) 15 minutes before the procedure.
• B. A transdermal fentanyl (Duragesic) patch at the site of venipuncture.
• C. EMLA (eutectic mixture of local anesthetics) immediately before the procedure.
• D. LMX (4% liposomal lidocaine cream) 30 minutes before the procedure.

Correct answer: D

Rationale: LMX is an effective analgesic agent when applied to the skin 30 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. TAC provides skin anesthesia about 15 minutes after application to nonintact skin, making it more suitable for wound suturing. Transdermal fentanyl patches are designed for continuous pain control, not rapid pain control needed for a procedure like venipuncture. EMLA, for maximum effectiveness, must be applied approximately 60 minutes before the procedure, making it less suitable for immediate pain relief required for intravenous line placement.

2. What urine test result is considered abnormal?

• A. pH 4.0
• B. WBC 1 or 2 cells/ml
• C. Protein level absent
• D. Specific gravity 1.020

Correct answer: A

Rationale: A urine pH of 4.0 is abnormally low, indicating possible acidosis or other metabolic conditions. WBC count of 1-2 cells/ml, absence of protein, and a specific gravity of 1.020 are within normal limits.

3. Why is knowledge of developmental theories useful for the nurse?

• A. Allows the nurse to know exactly what to do when caring for pediatric patients
• B. Is predictable and aids in controlling the child’s development
• C. Is a set of facts that each child follows in a prescribed method
• D. Provides a framework to guide the nurse in caring for the patient

Correct answer: D

Rationale: The correct answer is D. Understanding developmental theories helps nurses anticipate and plan appropriate care based on the child’s developmental stage. Choice A is incorrect because developmental theories provide a framework but do not dictate exact actions. Choice B is incorrect as developmental processes are not entirely predictable and are not meant to control a child’s development. Choice C is incorrect as developmental theories are not a strict set of facts that all children follow in a prescribed manner, but rather guidelines for understanding and supporting a child's growth and development.

4. A parent asks the nurse what would be the first indication that acute glomerulonephritis was improving. What would be the nurse's best response?

• A. Blood pressure will stabilize.
• B. Your child will have more energy.
• C. Urine will be free of protein.
• D. Urine output will increase.

Correct answer: D

Rationale: Increased urine output is often the first sign that acute glomerulonephritis is improving, as it indicates a reduction in fluid retention and better kidney function. Stabilization of blood pressure and other symptoms typically follow.

5. The mother of a 3-month-old breastfed infant asks about giving her baby water because it is summer and very warm. What should the nurse tell her?

• A. Fluids in addition to breast milk are not needed.
• B. Water should be given if the infant seems to nurse longer than usual.
• C. Clear juices are better than water to promote adequate fluid intake.
• D. Water once or twice a day will make up for losses resulting from environmental temperature.

Correct answer: A

Rationale: Breast milk provides adequate hydration, even in warm weather, so additional fluids like water are not necessary and can interfere with breastfeeding.

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