Nursing Elites

1. The parents of a 2-year-old child with a history of febrile seizures are being taught by the healthcare provider. Which statement by the parents indicates a need for further teaching?

• A. We should give our child acetaminophen when they have a fever.
• B. We should not place our child in a cool bath during a seizure.
• C. We should call 911 if the seizure lasts longer than 5 minutes.
• D. We should try to keep our child’s fever under control.

Correct answer: B

Rationale: Placing a child in a cool bath during a seizure is not recommended as it can be dangerous and may lead to accidental drowning or injuries. The priority during a febrile seizure is to ensure the safety of the child by placing them on a soft surface, removing any nearby objects that may cause harm, and gently turning their head to the side to prevent aspiration. Cooling measures like removing excess clothing can be employed, but immersing the child in a cool bath is not advised. Calling 911 if the seizure lasts longer than 5 minutes is important to seek immediate medical assistance. Administering acetaminophen to reduce fever and trying to keep the child's fever under control are appropriate interventions which should be continued.

2. A male infant with bronchiolitis is brought to the clinic by his mother. The infant is congested and febrile with a capillary refill of 2 seconds. Which information should the nurse discuss with the mother?

• A. Encourage the infant to play
• B. Limit the amount of oral intake
• C. Keep the infant isolated from others
• D. Place the infant on their back for naps

Correct answer: C

Rationale: Bronchiolitis is a highly contagious respiratory infection commonly caused by viruses. Isolating the infant from others is crucial to prevent the spread of the infection to other vulnerable individuals, especially those with weakened immune systems. Encouraging play may not be appropriate as the infant is sick and needs rest. Limiting oral intake might be necessary if the infant is having difficulty swallowing due to respiratory distress. Placing the infant on their back for naps is a safe sleep practice but not the priority in this situation where preventing transmission of the infection is crucial.

3. 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.

4. An adolescent female who is leaning forward with her hands on her knees to breathe tells the practical nurse that she has been using triamcinolone (Azmacort) inhalation aerosol before coming to the clinic. Which action should the PN implement?

• A. Obtain vital signs and assess breath sounds for wheezing.
• B. Collect a blood sample for white blood cell count.
• C. Give the client a nebulizer breathing treatment.
• D. Administer another dose of Azmacort.

Correct answer: A

Rationale: When a patient presents with breathing difficulties, the first action should be to assess vital signs and breath sounds to evaluate the severity of the condition. This assessment will provide crucial information to determine the appropriate course of action and treatment. Collecting a blood sample for a white blood cell count, giving a nebulizer treatment, or administering another dose of Azmacort would not be the initial priority in this situation. Therefore, option A is the correct choice as it focuses on assessing the patient's respiratory status to guide further interventions.

5. A 15-year-old client with type 1 diabetes presents to the clinic for a routine follow-up. The nurse notes that the client’s hemoglobin A1c is 10%. What should the nurse include in the plan of care?

• A. Increase the frequency of self-monitoring of blood glucose.
• B. Discuss dietary changes to reduce carbohydrate intake.
• C. Review the client’s insulin administration technique.
• D. All of the above

Correct answer: D

Rationale: A hemoglobin A1c of 10% indicates poor blood glucose control, reflecting an average blood sugar level over the past 2-3 months. To improve control, the plan of care should be comprehensive. Increasing the frequency of self-monitoring of blood glucose helps track changes in blood sugar levels. Discussing dietary changes to reduce carbohydrate intake can aid in better blood sugar management. Reviewing the client’s insulin administration technique ensures proper medication dosing. Therefore, all the options (increasing monitoring, discussing dietary changes, and reviewing insulin administration) are essential components of the plan of care to address the client's poor blood glucose control. The correct answer is D because all these interventions are crucial for managing the client's condition effectively. Choices A, B, and C individually address different aspects of diabetes management and are all necessary in this scenario.

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