Nursing Elites

1. What is an important nursing responsibility when a dysrhythmia is suspected?

• A. order an immediate electrocardiogram
• B. count the radial pulse every 1 minute for five times
• C. count the apical pulse for 1 full minute, and compare the rate with the radial pulse rate
• D. have someone else take the radial pulse simultaneously with the apical pulse

Correct answer: C

Rationale: When a dysrhythmia is suspected, an important nursing responsibility is to count the apical pulse for 1 full minute and then compare this rate with the radial pulse rate. This method helps in identifying dysrhythmias as it allows for a direct comparison of the heart's rhythm at two different pulse points. Ordering an immediate electrocardiogram (Choice A) may be necessary but should not be the first step. Counting the radial pulse multiple times (Choice B) is not as accurate as comparing rates directly. Having someone else take the radial pulse simultaneously (Choice D) may introduce errors and inconsistencies in the measurement.

2. A parent asks the nurse what they can do to help their child who is experiencing night terrors. What should the nurse suggest?

• A. Encourage the child to talk about the dream
• B. Establish a bedtime routine
• C. Allow the child to sleep with the parents
• D. Wake the child during the night

Correct answer: B

Rationale: Establishing a bedtime routine is the most appropriate suggestion for a child experiencing night terrors. Consistent bedtime routines help create a sense of security and predictability, reducing the likelihood of night terrors. Encouraging the child to talk about the dream (Choice A) may not be effective as night terrors occur during non-REM sleep, and the child may not remember the dreams. Allowing the child to sleep with the parents (Choice C) can reinforce dependency and may not address the underlying causes of night terrors. Waking the child during the night (Choice D) can disrupt their sleep cycle and worsen the occurrence of night terrors.

3. How should you care for an alert 4-year-old child with a mild airway obstruction, who has respiratory distress, a strong cough, and normal skin color?

• A. Back blows, abdominal thrusts, transport
• B. Oxygen, avoiding agitation, transport
• C. Assisting ventilations, back blows, transport
• D. Chest thrusts, finger sweeps, transport

Correct answer: B

Rationale: The correct approach for an alert 4-year-old child with a mild airway obstruction, respiratory distress, a strong cough, and normal skin color is to provide oxygen, avoid agitation, and arrange for transport. Oxygen helps support breathing, avoiding agitation prevents worsening of the obstruction, and transport ensures the child receives further medical evaluation and treatment. Choices A, C, and D involve techniques that are not recommended for a mild airway obstruction in this scenario. Back blows, abdominal thrusts, chest thrusts, and finger sweeps are interventions used for different situations and not suitable for a child with the described symptoms.

4. Upon assessing a newborn immediately after delivery, you note that the infant is breathing spontaneously and has a heart rate of 90 beats/min. What is the most appropriate initial management for this newborn?

• A. begin positive pressure ventilations
• B. provide blow-by oxygen with oxygen tubing
• C. assess the newborn's skin condition and color
• D. start chest compressions and contact medical control

Correct answer: A

Rationale: A heart rate below 100 beats/min in a newborn indicates the need for positive pressure ventilation to improve oxygenation. Providing positive pressure ventilations helps in assisting the newborn's breathing efforts to ensure adequate oxygenation. Choice B, providing blow-by oxygen, may not be sufficient to address the underlying issue of inadequate breathing. Choice C, assessing the newborn's skin condition and color, is important but not the most immediate action needed for a heart rate below 100 beats/min. Choice D, starting chest compressions, is not indicated as the infant is breathing spontaneously and has a heart rate, albeit lower than normal, which does not warrant chest compressions.

5. When teaching a class about trisomy 21, the instructor would identify the cause of this disorder as:

• A. nondisjunction.
• B. X-linked recessive inheritance.
• C. genomic imprinting.
• D. autosomal dominant inheritance.

Correct answer: A

Rationale: The correct answer is A: nondisjunction. Trisomy 21, also known as Down syndrome, is caused by nondisjunction, which is an error in cell division leading to an extra copy of chromosome 21. This additional genetic material alters the course of development and causes the characteristics associated with Down syndrome. Choices B, C, and D are incorrect. X-linked recessive inheritance refers to genetic disorders carried on the X chromosome, genomic imprinting involves gene expression based on parental origin, and autosomal dominant inheritance relates to disorders caused by a dominant gene on one of the non-sex chromosomes. In the case of trisomy 21, the cause is specifically related to the error in chromosome division, making nondisjunction the most appropriate answer.

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