Nursing Elites

1. A mother reports to the nurse at the pediatric clinic that her toddler has had a fever and sore throat for the past two days. The nurse observes several swollen red spots on the child's body, some of which are fluid-filled blisters. What action should the nurse take?

• A. Obtain a fluid culture from the blisters
• B. Administer a fever-reducing medication
• C. Cover the draining vesicles with a dressing
• D. Implement transmission precautions

Correct answer: D

Rationale: The presence of swollen red spots and fluid-filled blisters may indicate a contagious condition. Implementing transmission precautions is crucial to prevent the spread of the infection to others in the clinic setting.

2. The healthcare provider plans to administer 10 mcg/kg of digoxin elixir as a loading dose to a child who weighs 55 pounds. Digoxin is available as an elixir of 50 mcg/ml. How many milliliters of the digoxin elixir should the healthcare provider administer to this child?

• A. 5 ml
• B. 10 ml
• C. 15 ml
• D. 20 ml

Correct answer: A

Rationale: To calculate the dose, first, convert the child's weight to kilograms by dividing 55 pounds by 2.2, which equals approximately 25 kg. Then, multiply the weight by the dose (10 mcg/kg) to get the total dose needed, which is 250 mcg. Next, divide the total dose by the concentration of the elixir (50 mcg/ml) to determine the volume needed, which is 5 ml. Therefore, the correct dose is 5 ml based on the child's weight and the concentration of the elixir.

3. The mother of a one-month-old calls the clinic to report that the back of her infant's head is flat. How should the nurse respond?

• A. Turn the infant on the left side braced against the crib when sleeping.
• B. Prop the infant in a sitting position with a cushion when not sleeping.
• C. Place a small pillow under the infant's head while lying on the back.
• D. Position the infant on the stomach occasionally when awake and active.

Correct answer: D

Rationale: Positioning the infant on the stomach occasionally when awake and active can help prevent flat spots on the head. This position allows for more natural movement and prevents prolonged pressure on one area of the head, reducing the risk of developing a flat spot. Turning the infant on the left side braced against the crib when sleeping (choice A) is not recommended as it does not address the issue of flat spots. Propping the infant in a sitting position with a cushion when not sleeping (choice B) may increase the risk of falls and is not suitable for a one-month-old. Placing a small pillow under the infant's head while lying on the back (choice C) should be avoided due to the risk of suffocation and sudden infant death syndrome (SIDS).

4. What information should a nurse discuss with the mother of a 2-year-old girl who is drinking sweetened soda from her bottle?

• A. Encouraging 2-word phrases in speech development for a 2-year-old
• B. Explaining the association between drinking soda and dental caries
• C. Discussing the link between drinking soda and childhood obesity
• D. Emphasizing the importance of toddlers sleeping 10 hours a night

Correct answer: B

Rationale: The correct answer is explaining the association between drinking soda and dental caries. Soda consumption can lead to tooth decay and cavities, so it is crucial to educate the mother about this to prevent dental issues in the child.

5. During a well baby visit, the parents explain that a soft bulge appears in the groin of their 4-month-old son when he cries or strains during stooling. The infant is scheduled for surgical repair of the inguinal hernia in two weeks. What should the parent be instructed to do if the hernia becomes incarcerated prior to the surgery?

• A. Use a rectal thermometer to strain during stooling.
• B. Gently manipulate the hernia for reduction.
• C. Offer oral electrolyte fluids for comfort.
• D. Give acetaminophen or aspirin for crying.

Correct answer: B

Rationale: In the case of an incarcerated inguinal hernia, gentle manipulation can sometimes help in reducing it before surgery. This action should be taken cautiously and immediately followed by seeking medical attention. It is important to note that attempting reduction should be done by a healthcare professional, and parents should be advised to seek urgent medical care if the hernia becomes incarcerated. Using a rectal thermometer to strain during stooling (Choice A) is not the correct approach for an incarcerated hernia and can worsen the condition. Offering oral electrolyte fluids for comfort (Choice C) or giving acetaminophen or aspirin for crying (Choice D) are not appropriate interventions for an incarcerated hernia and may delay necessary medical treatment.

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