Nursing Elites

1. What are the most common signs and symptoms of leukemia related to bone marrow involvement?

• A. petechiae, infection, fatigue
• B. headache, papilledema, irritability
• C. muscle wasting, weight loss, fatigue
• D. decreased intracranial pressure, psychosis, confusion

Correct answer: A

Rationale: The correct answer is A: petechiae, infection, fatigue. In leukemia, bone marrow involvement leads to a decrease in normal blood cell production, resulting in petechiae (small red or purple spots on the skin), increased susceptibility to infections due to decreased white blood cells, and fatigue from anemia. Choices B, C, and D are incorrect because they do not directly relate to the typical signs and symptoms of leukemia with bone marrow involvement. Headache, papilledema, irritability, muscle wasting, weight loss, decreased intracranial pressure, psychosis, and confusion are not typically associated with leukemia and bone marrow involvement.

2. A child with a diagnosis of hemophilia is admitted to the hospital with a bleeding episode. What is the priority nursing intervention?

• A. Administering pain medication
• B. Monitoring for signs of infection
• C. Administering factor VIII
• D. Ensuring a safe environment

Correct answer: C

Rationale: The correct answer is administering factor VIII. Hemophilia is a genetic disorder characterized by a deficiency in clotting factors, such as factor VIII. Administering factor VIII is crucial in managing bleeding episodes in hemophiliac patients. Pain medication (Choice A) may be necessary but is not the priority in this situation. Monitoring for signs of infection (Choice B) is important for overall care but is not the priority during a bleeding episode. Ensuring a safe environment (Choice D) is also important but not the priority intervention when managing a bleeding episode in a child with hemophilia.

3. A 6-year-old child with asthma is admitted to the hospital with an acute exacerbation. What is the priority nursing intervention?

• A. Administering a bronchodilator
• B. Administering an antihistamine
• C. Administering a corticosteroid
• D. Administering oxygen

Correct answer: A

Rationale: Administering a bronchodilator is the priority intervention for a child experiencing an acute asthma exacerbation. Bronchodilators help to dilate the airways, making breathing easier and relieving acute symptoms of asthma. Antihistamines are not the first-line treatment for asthma exacerbations; they are more commonly used for allergic reactions. Corticosteroids are beneficial in reducing inflammation in asthma but are usually administered after bronchodilators to provide long-term control. Oxygen therapy may be necessary in severe cases of asthma exacerbation, but bronchodilators take precedence in improving airway patency and respiratory distress.

4. The nurse is implementing care for a school-age child admitted to the pediatric intensive care unit with diabetic ketoacidosis (DKA). Which prescribed intervention should the nurse implement first?

• A. Begin 0.9% saline solution intravenously as prescribed
• B. Administer regular insulin intravenously as prescribed
• C. Place the child on a cardiac monitor
• D. Place the child on a pulse oximetry monitor

Correct answer: A

Rationale: The correct first intervention when managing a child with diabetic ketoacidosis is to begin intravenous saline solution to address dehydration and restore electrolyte balance. Rehydration is essential to improve perfusion and correct electrolyte imbalances. Administering insulin without addressing dehydration can potentially lead to further complications. Placing the child on a cardiac monitor or pulse oximetry monitor is important but not the initial priority in managing DKA.

5. When assessing the perfusion status of a 2-year-old child with possible shock, which of the following parameters would be LEAST reliable?

• A. distal capillary refill
• B. systolic blood pressure
• C. skin color and temperature
• D. presence of peripheral pulses

Correct answer: B

Rationale: The correct answer is B: systolic blood pressure. In young children, systolic blood pressure is the least reliable parameter for assessing perfusion status. Factors such as anxiety, crying, and fear can significantly affect blood pressure measurements, leading to inaccuracies. Distal capillary refill, skin color and temperature, and presence of peripheral pulses are more reliable indicators of perfusion status in pediatric patients. Distal capillary refill assesses peripheral perfusion, skin color, and temperature reflect tissue perfusion, and the presence of peripheral pulses indicates blood flow to the extremities. Therefore, when evaluating a 2-year-old child with possible shock, focusing on parameters other than systolic blood pressure is crucial for an accurate assessment of perfusion status.

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