Nursing Elites

1. The mother of a 9-month-old girl provides the practical nurse with information about her daughter's diet. Which statement by the mother may indicate why the infant has been diagnosed with iron-deficiency anemia?

• A. She almost never drinks sugary water.
• B. She has been on whole milk for 7 months.
• C. She likes to chew on bread as a snack.
• D. She doesn't like to eat peaches or pears.

Correct answer: B

Rationale: The correct answer is B. Infants should not be given cow's milk before 1 year of age as it can interfere with iron absorption and lead to anemia. Choice A is incorrect as avoiding sugary water is actually a good practice. Choice C is unrelated to iron-deficiency anemia. Choice D, not liking peaches or pears, is also not directly related to iron-deficiency anemia.

2. The healthcare provider is preparing to administer a scheduled dose of digoxin to a 4-year-old child with heart failure. The healthcare provider notes that the child’s heart rate is 70 beats per minute. What should the healthcare provider do next?

• A. Administer the medication as prescribed
• B. Hold the medication and notify the healthcare provider
• C. Recheck the heart rate in 30 minutes
• D. Administer half of the prescribed dose

Correct answer: B

Rationale: In pediatric patients, digoxin administration is guided by the heart rate. If the child's heart rate is below the established threshold, which is typically 90-100 beats per minute in a 4-year-old, the medication should be withheld, and the healthcare provider should be notified for further evaluation and instructions. Choice A is incorrect because administering the medication when the heart rate is low can lead to adverse effects. Rechecking the heart rate in 30 minutes (Choice C) may delay necessary intervention if the heart rate remains low. Administering half of the prescribed dose (Choice D) is not recommended without healthcare provider guidance.

3. After observing a mother giving her 11-month-old ferrous sulfate followed by two ounces of orange juice, what should the nurse do next?

• A. Suggest placing the iron drops in the orange juice and feed the infant.
• B. Tell the mother to follow the iron drops with formula instead of orange juice.
• C. Instruct the mother to feed the infant nothing in the next 30 minutes after the iron.
• D. Give positive feedback about the way she administered the sulfate.

Correct answer: D

Rationale: Providing positive feedback to the mother for correctly administering the iron supplements is essential as it reinforces proper medication administration practices. This encouragement can help build the mother's confidence and ensure that she continues to administer the supplements correctly in the future, promoting the infant's health and well-being. Choices A, B, and C are incorrect because there is no need to suggest altering the administration method, changing the liquid used, or restricting feeding immediately after administering the iron supplement. Giving positive feedback is the most appropriate action in this scenario to acknowledge the mother's correct administration technique.

4. A 16-year-old adolescent with cystic fibrosis is admitted to the hospital with a respiratory infection. The nurse is teaching the adolescent about the importance of airway clearance techniques. Which statement by the adolescent indicates a need for further teaching?

• A. I should do my airway clearance exercises every day.
• B. I don’t need to do my airway clearance exercises if I feel okay.
• C. Airway clearance helps prevent mucus buildup in my lungs.
• D. I should continue my airway clearance routine even when I’m not sick.

Correct answer: B

Rationale: The correct answer is B. Airway clearance exercises are essential for individuals with cystic fibrosis to prevent mucus buildup in their lungs. It is crucial to perform these exercises regularly, even when feeling well, to maintain lung health and prevent complications. Choice A is correct as doing airway clearance exercises daily is necessary. Choice C is also accurate as airway clearance does indeed help prevent mucus buildup. Choice D is correct as it is important to continue the airway clearance routine even when not sick to maintain lung health. Choice B is incorrect because stating that airway clearance exercises are unnecessary when feeling okay demonstrates a misunderstanding of the importance of consistent airway clearance in cystic fibrosis management.

5. What should the nurse do first for a 6-year-old with asthma showing a prolonged expiratory phase, wheezing, and 35% of personal best peak expiratory flow rate (PEFR)?

• A. Administer a prescribed bronchodilator.
• B. Encourage the child to cough and take deep breaths.
• C. Report the findings to the healthcare provider.
• D. Identify the triggers that precipitated this attack.

Correct answer: A

Rationale: Administering a bronchodilator is the priority action in managing an acute asthma exacerbation in a child. Bronchodilators help to relax the muscles around the airways, opening them up and improving breathing. This intervention aims to address the immediate breathing difficulty and should be done promptly to provide relief for the child. Encouraging coughing and deep breaths (choice B) may worsen the child's condition by further constricting the airways. Reporting findings to the healthcare provider (choice C) is important but not the immediate priority in this acute situation. Identifying triggers (choice D) is crucial for long-term asthma management but is not the first step when managing an acute exacerbation.

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