Nursing Elites

1. What is the recommended analgesia for preparing a school-age child for a lumbar puncture (LP)?

• A. Ondansetron (Zofran) 4 mg / 5 ml PO TID.
• B. Codeine 10 mg PO 30 minutes before the procedure.
• C. A transdermal fentanyl (Duragesic) patch immediately before the procedure.
• D. EMLA (eutectic mixtures of local anesthetics) 2.5 hours before the procedure.

Correct answer: D

Rationale: For a lumbar puncture in a school-age child, EMLA cream should be applied 2.5 hours before the procedure. EMLA is commonly used to numb the skin, reducing pain and discomfort for the child during the procedure. Choices A, B, and C are incorrect because ondansetron is an antiemetic, codeine is an opioid analgesic that may not be suitable for children, and transdermal fentanyl is a strong opioid that is not typically used for local anesthesia in children undergoing lumbar puncture.

2. 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.

3. What action should be taken by the healthcare provider for a child who has ingested a corrosive product?

• A. Induce vomiting using Ipecac to remove the corrosive agent.
• B. Administer vinegar or lemon juice to neutralize the caustic agent.
• C. Give activated charcoal to decontaminate the stomach.
• D. Telephone the poison control center and follow their advice.

Correct answer: D

Rationale: In cases of corrosive product ingestion, it is crucial to contact the poison control center for guidance. Inducing vomiting or attempting to neutralize the agent can lead to further harm. The poison control center professionals are trained to provide specific instructions tailored to the situation, ensuring the best possible outcome for the child. Therefore, the correct action is to call the poison control center for appropriate advice. Inducing vomiting can cause additional damage by re-exposing the esophagus and mouth to the corrosive substance. Administering vinegar or lemon juice is not recommended as it may worsen the situation by causing a chemical reaction. While activated charcoal can be useful in some cases of poisoning, it is not recommended for corrosive substances as it is ineffective in binding to them.

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 mother brings her 3-month-old infant to the clinic because the baby does not sleep through the night. Which finding is most significant in planning care for this family?

• A. The mother is a single parent and lives with her parents
• B. The mother states the baby is irritable during feedings
• C. The infant’s formula has been changed twice
• D. The diaper area shows severe skin breakdown

Correct answer: D

Rationale: Severe skin breakdown in the diaper area is a significant finding indicating a potential health issue that needs immediate attention. It may be a sign of a skin condition, such as a diaper rash, which can cause discomfort and pain for the infant. Addressing this concern promptly is crucial to prevent further complications and ensure the baby's well-being. The other choices may also be important in assessing the overall situation of the family, but in terms of immediate care for the infant, the severe skin breakdown takes priority.

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