Nursing Elites

1. The caregiver is being educated by a healthcare provider about the use of a metered-dose inhaler (MDI) for their 8-year-old child with asthma. Which statement by the caregiver indicates a need for further teaching?

• A. I will shake the inhaler before each use
• B. My child should breathe in quickly after pressing the inhaler
• C. I should wait a minute between puffs
• D. We should use a spacer with the inhaler

Correct answer: B

Rationale: The caregiver should be informed that the child should breathe in slowly and deeply after pressing the inhaler. This allows for better medication delivery to the lungs and ensures optimal effectiveness of the treatment.

2. In a hospitalized child receiving IV fluids for dehydration, what is the best indicator that the child’s dehydration is improving?

• A. The child’s urine output increases
• B. The child’s skin turgor is normal
• C. The child’s weight increases
• D. The child’s vital signs are stable

Correct answer: A

Rationale: An increase in urine output is a reliable indicator of improving dehydration in a child. It signifies that the kidneys are functioning better, helping to restore fluid balance in the body. Monitoring urine output is crucial in assessing hydration status and response to treatment. Choices B, C, and D are not the best indicators of improving dehydration. Normal skin turgor is helpful but may not change immediately with improving hydration. Weight increase may reflect retained fluids rather than improved hydration status. Stable vital signs are important but may not always indicate improving dehydration.

3. A toddler with a chronic illness that requires frequent hospitalization is likely to experience which psychosocial developmental challenge?

• A. Fixation with feelings of inadequacy
• B. Interference with the development of autonomy
• C. Distortion of differentiation of self from parent
• D. Delayed language, fine-motor, and self-care skills

Correct answer: B

Rationale: Toddlers with chronic illnesses requiring frequent hospitalization may experience interference with the development of autonomy. This is because the need for constant medical care can restrict their independence and ability to explore and make choices, which are essential aspects of achieving autonomy according to Erikson's stages of psychosocial development. Choices A, C, and D are incorrect. Fixation with feelings of inadequacy (Choice A) is more commonly associated with Erikson's stage of industry vs. inferiority in middle childhood. Distortion of differentiation of self from parent (Choice C) is related to the separation-individuation phase of Mahler's theory of object relations, typically occurring in infancy. Delayed language, fine-motor, and self-care skills (Choice D) may be impacted by chronic illness but are not the primary psychosocial developmental challenge faced by toddlers in this context.

4. A 5-year-old child with leukemia is receiving chemotherapy. The nurse notes that the child’s white blood cell count is low. What is the nurse’s priority intervention?

• A. Administer antibiotics as prescribed
• B. Place the child in protective isolation
• C. Encourage the child to eat a balanced diet
• D. Teach the parents about infection prevention

Correct answer: B

Rationale: The priority intervention for a 5-year-old child with leukemia receiving chemotherapy and having a low white blood cell count is to place the child in protective isolation. This intervention helps reduce the risk of infection, which is crucial in this immunocompromised state. Protective isolation aims to limit the child's exposure to pathogens and promote their safety during a period of increased vulnerability to infections.

5. During a well-baby check of a 7-month-old infant, the practical nurse notes an absence of babbling. Which focused assessment should the PN implement?

• A. Visual function.
• B. Auditory function.
• C. Cognitive function.
• D. Social development.

Correct answer: B

Rationale: The absence of babbling in a 7-month-old infant is a concerning auditory development milestone. Babbling is an early stage of language development that involves making various sounds. A lack of babbling could indicate a hearing impairment or other auditory issues. Therefore, the practical nurse should focus on assessing the infant's auditory function to determine if further evaluation or intervention is necessary. Choices A, C, and D are incorrect because the absence of babbling specifically points towards a potential issue related to auditory function rather than visual, cognitive, or social development.

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