Nursing Elites

1. The healthcare provider notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of

• A. poor appetite
• B. increased potassium intake
• C. reduction of edema
• D. restriction to bed rest

Correct answer: C

Rationale: In acute glomerulonephritis, weight loss is most likely due to the reduction of edema. Edema is a common symptom of glomerulonephritis, which causes fluid retention and swelling in the body. As treatment progresses and the condition improves, the reduction of edema leads to weight loss. Choices A, B, and D are incorrect as they do not directly address the underlying pathophysiology of acute glomerulonephritis and its impact on weight loss.

2. You are called to a residence for a 'sick' 5-year-old child. When you arrive and begin your assessment, you note that the child is unconscious with a respiratory rate of 8 breaths/min and a heart rate of 50 beats/min. Management of this child should consist of

• A. 100% oxygen via a non-rebreathing mask and rapid transport
• B. positive pressure ventilations with a BVM device and rapid transport
• C. chest compressions, artificial ventilations, and rapid transport
• D. back blows and chest thrusts while attempting artificial ventilations

Correct answer: C

Rationale: In a 5-year-old child who is unconscious with a respiratory rate of 8 breaths/min and a heart rate of 50 beats/min, the priority is to initiate chest compressions, artificial ventilations, and rapid transport. These vital interventions are crucial in cases of severe respiratory and cardiovascular compromise. Choice A is incorrect because administering 100% oxygen alone may not address the underlying issues of inadequate ventilation and circulatory support. Choice B is not the most appropriate initial intervention in this scenario; chest compressions should precede positive pressure ventilations. Choice D is incorrect as back blows and chest thrusts are indicated in choking emergencies, not in this case of respiratory and cardiovascular compromise.

3. A 16-year-old is suspected of having type 1 diabetes mellitus. Which clinical manifestation may be present?

• A. moist skin
• B. weight gain
• C. fluid overload
• D. poor wound healing

Correct answer: D

Rationale: Poor wound healing is a common clinical manifestation of type 1 diabetes mellitus. High blood glucose levels in diabetes can impair the body's ability to heal wounds effectively. Choices A, B, and C are incorrect. Moist skin is not a typical clinical manifestation of type 1 diabetes; instead, skin may become dry due to dehydration. Weight gain is unlikely as type 1 diabetes is characterized by weight loss. Fluid overload is also uncommon in type 1 diabetes, which is more commonly associated with dehydration due to frequent urination.

4. Which of the following statements regarding 2-rescuer child CPR is correct?

• A. The chest should not be allowed to fully recoil in between compressions as this may impede venous return.
• B. Compress the chest with one or two hands to a depth equal to one-half to one third the diameter of the chest.
• C. The chest should be compressed with one hand and a compression to ventilation ratio of 30:2 should be delivered.
• D. A compression to ventilation ratio of 15:2 should be delivered without pauses in compressions to deliver ventilations.

Correct answer: B

Rationale: The correct statement regarding 2-rescuer child CPR is to compress the chest with one or two hands to a depth equal to one-half to one third the diameter of the chest. This technique ensures effective chest compressions without causing excessive damage to the chest. Choice A is incorrect because allowing the chest to fully recoil between compressions is essential to facilitate optimal blood flow during CPR. Choice C is incorrect as it describes a compression to ventilation ratio of 30:2, which is not the recommended ratio for child CPR. Choice D is incorrect as a compression to ventilation ratio of 15:2 is not standard practice for child CPR, and pauses in compressions are necessary to provide ventilations effectively.

5. When administering IV fluids to a dehydrated infant, what intervention is most important at this time?

• A. Continuing the prescribed flow rate
• B. Monitoring the intravenous drop rate
• C. Calculating the total necessary intake
• D. Maintaining the fluid at body temperature

Correct answer: B

Rationale: Monitoring the intravenous drop rate is crucial when administering IV fluids to ensure that the correct amount of fluids is delivered to the dehydrated infant. Choice A assumes the initial rate is correct without ongoing assessment. Choice C, while important, does not address the immediate need for monitoring the infusion rate. Choice D, maintaining the fluid at body temperature, is essential for comfort but is not as critical as ensuring the correct fluid delivery rate. By monitoring the intravenous drop rate, healthcare providers can adjust the flow as needed to prevent overhydration or underhydration, helping to manage the infant's fluid balance effectively.

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