Nursing Elites

1. The mother of an 11-year-old boy with juvenile arthritis tells the nurse, 'I really don’t want my son to become dependent on pain medication, so I only allow him to take it when he is really hurting.' Which information is most important for the nurse to provide this mother?

• A. Encouraging the child to rest when he experiences pain
• B. Encouraging quiet activities like watching television as a pain distractor
• C. Suggesting the use of hot baths as an alternative to pain medication
• D. Explaining that giving pain medication around the clock helps control the pain

Correct answer: D

Rationale: The nurse should educate the mother that giving pain medication around the clock helps maintain a consistent level of pain control, preventing severe pain episodes and improving the child's quality of life. It is essential to manage pain proactively rather than waiting for the child to be in severe pain before administering medication. Choices A, B, and C do not address the importance of proactive pain management and maintaining a consistent level of pain control. Encouraging rest, quiet activities, or hot baths as distractions or alternatives may not provide adequate pain relief for the child with juvenile arthritis, and they do not address the underlying issue of effective pain management.

2. A child who is admitted to the hospital with anemia is anxious, fearful, and hyperventilating. The nurse anticipates the child developing which acid-base imbalance?

• A. Metabolic acidosis
• B. Respiratory acidosis
• C. Respiratory alkalosis
• D. Metabolic alkalosis

Correct answer: C

Rationale: In this scenario, the child is hyperventilating, which leads to excessive loss of carbon dioxide. This loss of carbon dioxide causes respiratory alkalosis due to a decrease in the partial pressure of carbon dioxide in the blood. Therefore, the correct answer is respiratory alkalosis. Choices A, B, and D are incorrect. Metabolic acidosis is characterized by a decrease in pH and bicarbonate levels due to conditions like kidney disease. Respiratory acidosis is caused by retention of carbon dioxide, leading to an increase in the partial pressure of carbon dioxide. Metabolic alkalosis results from a loss of acid or an increase in bicarbonate levels.

3. A child with acute lymphocytic leukemia (ALL) who is receiving chemotherapy via a subclavian IV infusion has an oral temperature of 103 degrees. In assessing the IV site, the nurse determines that there are no signs of infection at the site. Which intervention is the most important for the nurse to implement?

• A. Obtain a specimen for blood cultures.
• B. Assess the CBC.
• C. Monitor the oral temperature every hour.
• D. Administer acetaminophen as prescribed.

Correct answer: A

Rationale: Obtaining a specimen for blood cultures is crucial in this situation as it helps identify the source of infection, if present, and guide appropriate treatment. This is important in a child with leukemia receiving chemotherapy to prevent potential complications and ensure timely intervention. Assessing the CBC may provide overall information on the child's condition but may not specifically identify a potential infection. Monitoring the oral temperature is important but obtaining blood cultures takes precedence in this scenario. Administering acetaminophen can help reduce fever but does not address the need to identify a possible infection source.

4. An 8-year-old male client with nephrotic syndrome is receiving salt-poor human albumin IV. Which findings indicate to the nurse that the child is manifesting a therapeutic response?

• A. Decreased urinary output
• B. Decreased periorbital edema
• C. Increased periods of rest
• D. Weight gain of 0.5 kg/day

Correct answer: B

Rationale: In nephrotic syndrome treatment, decreased periorbital edema is a positive therapeutic response as it indicates a reduction in fluid retention. Periorbital edema is a common symptom of nephrotic syndrome due to fluid accumulation, so a decrease in this swelling signifies an improvement in the condition.

5. The heart rate for a 3-year-old with a congenital heart defect has steadily decreased over the last few hours, now it's 76 bpm, the previous reading 4 hours ago was 110 bpm. Which additional finding should be reported immediately to a healthcare provider?

• A. Oxygen saturation 94%.
• B. RR of 25 breaths/minute.
• C. Urine output 20 mL/hr.
• D. BP 70/40.

Correct answer: D

Rationale: A significant drop in heart rate and blood pressure should be reported immediately as it may indicate worsening of the congenital heart defect. A decrease in blood pressure may suggest poor cardiac output and compromised perfusion, requiring urgent medical attention. The other findings (oxygen saturation of 94%, RR of 25 breaths/minute, and urine output of 20 mL/hr) are within normal ranges for a 3-year-old and do not indicate immediate deterioration of the heart defect.

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