Nursing Elites

1. The healthcare provider plans to administer 10 mcg/kg of digoxin elixir as a loading dose to a child who weighs 55 pounds. Digoxin is available as an elixir of 50 mcg/ml. How many milliliters of the digoxin elixir should the healthcare provider administer to this child?

• A. 5 ml
• B. 10 ml
• C. 15 ml
• D. 20 ml

Correct answer: A

Rationale: To calculate the dose, first, convert the child's weight to kilograms by dividing 55 pounds by 2.2, which equals approximately 25 kg. Then, multiply the weight by the dose (10 mcg/kg) to get the total dose needed, which is 250 mcg. Next, divide the total dose by the concentration of the elixir (50 mcg/ml) to determine the volume needed, which is 5 ml. Therefore, the correct dose is 5 ml based on the child's weight and the concentration of the elixir.

2. The healthcare provider plans to screen only the highest risk children for scoliosis. Which group of children should the healthcare provider screen first?

• A. Girls between ages 10 and 14.
• B. Boys between ages 10 and 14.
• C. Boys and girls between 12 and 14.
• D. Boys and girls between 8 and 12.

Correct answer: A

Rationale: Corrected Question: The healthcare provider plans to screen only the highest risk children for scoliosis. Which group of children should the healthcare provider screen first? Girls between ages 10 and 14 are at the highest risk for scoliosis and should be screened first as they have a higher incidence of developing scoliosis during their adolescent growth spurt. Early detection and intervention can help prevent further complications associated with scoliosis. Boys between ages 10 and 14 (choice B) are not at the highest risk compared to girls in the same age group. Boys and girls between 12 and 14 (choice C) are at a lower risk compared to girls between ages 10 and 14. Boys and girls between 8 and 12 (choice D) are at a lower risk group compared to girls between ages 10 and 14.

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 is how often the MDI is used daily. This is crucial to assess if the symptoms of insomnia, shakiness, and rapid heart rate are related to overuse of the inhaler, leading to potential side effects such as systemic effects of beta-2 agonists.

4. 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.

5. The parents of a 3-month-old infant are being educated by the healthcare provider about safe sleep practices. Which statement by the parents indicates a need for further teaching?

• A. We will place our baby on their back to sleep
• B. We will use a firm mattress and avoid soft bedding
• C. We will keep our baby in our bed so we can monitor them closely
• D. We will avoid putting toys or pillows in the crib

Correct answer: C

Rationale: The correct answer is C. Co-sleeping, or keeping the baby in the parents' bed, increases the risk of sudden infant death syndrome (SIDS). It is crucial for parents to place the baby in a separate crib or bassinet to ensure a safe sleep environment and reduce the risk of SIDS. Choices A, B, and D demonstrate understanding of safe sleep practices by mentioning placing the baby on their back, using a firm mattress and avoiding soft bedding, and not putting toys or pillows in the crib, which are all measures to promote safe sleep and reduce the risk of SIDS.

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