Nursing Elites

1. A 10-year-old child is being discharged after being admitted for status asthmaticus. Which instruction is most important for the nurse to include in the discharge teaching?

• A. Use a peak flow meter daily to monitor asthma control
• B. Avoid exposure to known allergens
• C. Continue taking asthma medications as prescribed
• D. Seek emergency care if symptoms worsen

Correct answer: A

Rationale: Using a peak flow meter daily is crucial as it helps monitor asthma control by measuring how well the child's lungs are functioning. This monitoring can indicate when intervention is needed before symptoms worsen or become severe, allowing for timely management of asthma exacerbations.

2. 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.

3. A 16-year-old female student with a history of asthma controlled with both an oral antihistamine and an albuterol (Proventil) metered-dose inhaler (MDI) comes to the school nurse. The student complains that she cannot sleep at night, feels shaky and her heart feels like it is 'beating a mile a minute.' Which information is most important for the nurse to obtain?

• A. When she last took the antihistamine.
• B. When her last asthma attack occurred.
• C. Duration of most asthma attacks.
• D. How often the MDI is used daily.

Correct answer: D

Rationale: The most important information for the nurse to obtain in this scenario is how often the MDI is used daily. This is crucial to assess if the symptoms the student is experiencing, such as insomnia, shakiness, and tachycardia, could be related to overuse of the inhaler. Overuse of albuterol can lead to side effects like tremors, palpitations, and difficulty sleeping, so understanding the frequency of MDI use is key in determining a potential cause for the student's symptoms. Options A, B, and C are not as pertinent in this situation as they do not directly address the possible link between the student's symptoms and the use of the albuterol MDI.

4. A mother brings her 8-month-old baby boy to the clinic because he has been vomiting and having diarrhea for the last 3 days. Which assessment is most important for the nurse to make?

• A. Assess the infant's abdomen for tenderness
• B. Determine if the infant has been exposed to a virus
• C. Measure the infant’s pulse
• D. Evaluate the infant’s cry

Correct answer: C

Rationale: The most crucial assessment in this scenario is to measure the infant's pulse. Pulse measurement is essential to evaluate the severity of dehydration, which can be a significant concern in a baby experiencing vomiting and diarrhea for several days. Assessing the abdomen for tenderness may provide information on potential causes of symptoms but is not as urgent as monitoring hydration status. Determining exposure to a virus is important for infection control but does not directly address the immediate issue of dehydration. Evaluating the infant's cry, although a form of communication, does not provide critical information regarding the baby's physiological status in this situation.

5. When screening a 5-year-old for strabismus, what action should the nurse take?

• A. Have the child identify colored patterns on polychromatic cards.
• B. Direct the child through the six cardinal positions of gaze.
• C. Inspect the child for the setting sun sign.
• D. Observe the child for blank, sunken eyes.

Correct answer: B

Rationale: When screening a 5-year-old for strabismus, directing the child through the six cardinal positions of gaze is the most appropriate action. This method helps the nurse to assess eye alignment, which is crucial in identifying any misalignment that may indicate strabismus. Choices A, C, and D are incorrect. Having the child identify colored patterns on polychromatic cards is more related to visual acuity testing rather than strabismus screening. Inspecting the child for the setting sun sign is not a standard method for strabismus screening. Observing the child for blank, sunken eyes is not specific to strabismus assessment.

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