Nursing Elites

1. Fred, a 12-year-old boy, is diagnosed with pneumococcal pneumonia. Which of the following symptoms would Nurse Nica expect to assess?

• A. Mild cough
• B. Slight fever
• C. Chest pain
• D. Bulging fontanel

Correct answer: C

Rationale: Chest pain is a common symptom associated with pneumococcal pneumonia. It can occur due to inflammation of the pleura or irritation of the lung tissue, leading to sharp or stabbing pain that worsens with breathing or coughing. While cough and fever are also common with pneumonia, chest pain is particularly significant in this case.

2. When ventilating an apneic 3-year-old child with a bag-valve mask device, what is the MOST important action to take?

• A. Avoid hyperventilation and ensure adequate chest rise.
• B. Squeeze the bag with both hands and use a pediatric mask.
• C. Immediately insert an oropharyngeal airway.
• D. Provide one breath every 3 to 5 seconds.

Correct answer: A

Rationale: When ventilating an apneic child, the most important action is to avoid hyperventilation and ensure adequate chest rise. Hyperventilation can lead to decreased cardiac output and increased intracranial pressure. Adequate chest rise confirms effective ventilation and minimizes the risk of complications. Choice B is incorrect because using both hands to squeeze the bag may not ensure proper ventilation and can lead to complications. Choice C is incorrect as inserting an oropharyngeal airway is not the initial action in ventilating an apneic child with a bag-valve mask. Choice D is incorrect as providing ventilations every 3 to 5 seconds may not be appropriate for effective ventilation in a pediatric patient.

3. When assessing a 6-year-old boy with pain in the right lower quadrant of his abdomen, which action should be performed first?

• A. Avoiding palpation of the abdomen.
• B. Palpating the right lower quadrant first.
• C. Auscultating bowel sounds for 2 minutes.
• D. Palpating the left upper quadrant first.

Correct answer: D

Rationale: Palpating the left upper quadrant first is the correct approach when assessing abdominal pain in a child. This method helps to minimize causing additional discomfort to the child and allows for a more accurate assessment of their reaction to palpation. By starting on the left upper quadrant, you can gauge the child's pain response before moving to the area of complaint, which may be more sensitive. This approach is essential for a thorough and less distressing abdominal assessment in pediatric patients.

4. A 4-year-old boy ingested an unknown quantity of drain cleaner. He is alert, has a patent airway, and has adequate breathing. You should:

• A. administer 1 g/kg of activated charcoal.
• B. give 15 mL of ipecac and contact medical control.
• C. contact poison control and give him oxygen.
• D. give oxygen and perform a head-to-toe exam.

Correct answer: C

Rationale: When a child ingests a harmful substance like drain cleaner and remains alert with a patent airway and adequate breathing, the initial steps involve contacting poison control to guide further management. In this scenario, providing oxygen to support respiratory function is essential until definitive care is established. Activated charcoal and ipecac are not recommended in the management of ingested caustic substances like drain cleaner. Performing a head-to-toe exam can wait until the child's immediate respiratory needs are addressed and the poison control center has provided guidance on further management.

5. What action should you take if a newborn's heart rate is 50 beats/min?

• A. Begin chest compressions.
• B. Reassess in 30 seconds.
• C. Administer blow-by oxygen.
• D. Start positive-pressure ventilations.

Correct answer: D

Rationale: If a newborn's heart rate is below 60 beats per minute, the appropriate action is to start positive-pressure ventilations. Ventilations help deliver oxygen to the newborn's body and support respiratory function, which is critical in cases of bradycardia. Chest compressions are not recommended until the heart rate is below 60 despite adequate ventilation. Reassessment is essential but not the immediate action required in this scenario. Administering blow-by oxygen alone may not effectively address the underlying cause of bradycardia, making positive-pressure ventilations the priority intervention in this case.

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