Nursing Elites

1. The practical nurse is caring for a child who was admitted for treatment of seizures. Which intervention should the nurse implement to help prevent injury from a seizure?

• A. Have a padded tongue depressor at the bedside.
• B. Keep the side rails padded and in an upright position.
• C. Place a padded helmet on the child’s head.
• D. Restrain the child during the seizure activity.

Correct answer: B

Rationale: The correct intervention to help prevent injury during a seizure is to keep the side rails padded and in an upright position. This measure helps to ensure the child's safety by preventing falls or accidental injuries. Using a padded tongue depressor or restraining the child can potentially cause harm and are not recommended. Placing a padded helmet is not a standard intervention for seizure safety in this scenario.

2. The practical nurse is reinforcing information about Lyme disease prevention with a client who is preparing for a camping trip with family. Which statement by the client informs the nurse that the client understands the instruction?

• A. I'll make sure my son wears dark clothing on his hike.
• B. I'll get a prescription for amoxicillin to take with us.
• C. We should all get the Lyme disease vaccine before our trip.
• D. We will wear long pants and long-sleeved shirts in the woods.

Correct answer: D

Rationale: The correct answer is D. Wearing long pants and long-sleeved shirts is an effective preventive measure against tick bites, which reduces the risk of contracting Lyme disease. This attire helps to minimize skin exposure to ticks, thereby decreasing the chances of a tick attaching and transmitting the disease-causing bacteria.

3. 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.

4. The mother of a 9-month-old girl provides the practical nurse with information about her daughter's diet. Which statement by the mother may indicate why the infant has been diagnosed with iron-deficiency anemia?

• A. She almost never drinks sugary water.
• B. She has been on whole milk for 7 months.
• C. She likes to chew on bread as a snack.
• D. She doesn't like to eat peaches or pears.

Correct answer: B

Rationale: The correct answer is B. Infants should not be given cow's milk before 1 year of age as it can interfere with iron absorption and lead to anemia. Choice A is incorrect as avoiding sugary water is actually a good practice. Choice C is unrelated to iron-deficiency anemia. Choice D, not liking peaches or pears, is also not directly related to iron-deficiency anemia.

5. A 14-year-old client with type 1 diabetes is participating in a school sports event. The nurse provides education to the client about managing blood glucose levels during physical activity. Which statement by the client indicates a need for further teaching?

• A. I should check my blood sugar before and after exercise
• B. I need to eat a snack before I start playing
• C. If my blood sugar is high, I should skip my insulin dose before exercise
• D. I should carry a fast-acting carbohydrate with me during sports

Correct answer: C

Rationale: The correct answer is C. Skipping the insulin dose when blood sugar is high before exercise can be harmful. It is essential to manage blood glucose levels carefully during physical activity, which may require adjustments to insulin doses but skipping doses is not recommended. Checking blood sugar before and after exercise (Choice A) helps in monitoring and managing blood glucose levels. Eating a snack before playing (Choice B) can help maintain blood sugar levels during physical activity. Carrying a fast-acting carbohydrate (Choice D) is important in case of low blood sugar during sports to quickly raise glucose levels. Therefore, the client needs further teaching on the importance of not skipping insulin doses even if blood sugar is high before exercise.

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