Nursing Elites

1. When caring for a child experiencing severe asthma symptoms, which medication should the practical nurse anticipate being administered first?

• A. Inhaled corticosteroids.
• B. Oral corticosteroids.
• C. Short-acting beta agonists.
• D. Leukotriene receptor antagonists.

Correct answer: C

Rationale: In the management of acute asthma exacerbations, the first-line medication for quick relief of bronchoconstriction is a short-acting beta agonist, such as albuterol. These medications help to rapidly open up the airways, providing immediate relief to the patient. Inhaled corticosteroids are more commonly used for long-term control of asthma symptoms, while oral corticosteroids and leukotriene receptor antagonists are often reserved for more severe or chronic cases. Therefore, in a child experiencing severe asthma symptoms, the practical nurse should anticipate the administration of short-acting beta agonists as the initial intervention to provide quick relief and improve breathing.

2. A 9-year-old child with a history of type 1 diabetes is brought to the clinic for a check-up. The nurse notes that the child's hemoglobin A1c is 8.5%. What is the most appropriate action for the nurse to take?

• A. Increase the child’s insulin dose
• B. Review the child’s dietary habits and insulin administration technique
• C. Discuss the possibility of switching to oral hypoglycemics
• D. Schedule a follow-up appointment in three months

Correct answer: B

Rationale: A hemoglobin A1c of 8.5% indicates suboptimal diabetes control. The most appropriate action for the nurse in this scenario is to review the child’s dietary habits and insulin administration technique. This approach can help identify potential areas for improvement and optimize diabetes management, aiming to lower the hemoglobin A1c levels towards the target range. Increasing the child’s insulin dose (Choice A) without addressing dietary habits and administration technique may not lead to better control and can increase the risk of hypoglycemia. Switching to oral hypoglycemics (Choice C) is not appropriate for type 1 diabetes management. Scheduling a follow-up appointment in three months (Choice D) without intervening to improve diabetes control is not the best immediate action.

3. What action should the nurse take when a child presents with fever, sore throat, swollen red spots, and fluid-filled blisters?

• A. Obtain a fluid culture from the blisters
• B. Administer a fever-reducing medication
• C. Cover the drainage vesicles with a dressing
• D. Implement transmission precautions

Correct answer: D

Rationale: When a child presents with fever, sore throat, swollen red spots, and fluid-filled blisters, it may indicate a contagious viral infection. In such cases, implementing transmission precautions is crucial to prevent the spread of the infection to others in the pediatric clinic or community. Obtaining a fluid culture from the blisters (Choice A) may not be necessary at the initial stage without knowing the cause of the infection. Administering a fever-reducing medication (Choice B) may help manage symptoms but doesn't address the need for preventing transmission. Covering the drainage vesicles with a dressing (Choice C) may provide comfort to the child but does not directly address the risk of transmission to others.

4. The healthcare provider is developing the plan of care for a hospitalized child with von Willebrand disease. What priority nursing intervention should be included in this child's plan of care?

• A. Reduce exposure to infection.
• B. Eliminate contact with cold objects.
• C. Guard against bleeding injuries.
• D. Reduce contact with other children.

Correct answer: C

Rationale: Children with von Willebrand disease have a deficiency in a clotting protein, putting them at risk of bleeding episodes. The priority nursing intervention for a child with von Willebrand disease is to guard against bleeding injuries to prevent excessive bleeding or hemorrhage. Choices A, B, and D are not the priority interventions for von Willebrand disease. While reducing exposure to infection is important for any hospitalized child, it is not the priority for von Willebrand disease. Eliminating contact with cold objects is more relevant for conditions like Raynaud's disease. Reducing contact with other children is not a specific priority related to managing von Willebrand disease.

5. When a 3-year-old boy asks a nurse why his baby sister is eating his mommy’s breast, how should the nurse respond? (Select the response that does not apply.)

• A. Remind him that his mother breastfed him too
• B. Clarify that breastfeeding is the mother’s choice
• C. Reassure the older brother that it does not hurt his mother
• D. Explain that newborns get milk from their mothers in this way

Correct answer: A

Rationale: In this scenario, the nurse should avoid reminding the older sibling about his own breastfeeding experience as it does not directly address the question posed by the boy. Providing simple explanations about breastfeeding and newborn feeding patterns helps the older sibling understand the natural process without bringing up personal experiences. Choice B is correct because clarifying that breastfeeding is the mother's choice helps the older sibling understand the concept of personal decisions. Choice C is appropriate as reassuring the older brother that it does not hurt his mother addresses a common concern children may have. Choice D is also suitable as it explains in simple terms how newborns receive milk from their mothers.

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