Nursing Elites

1. What should an adolescent with type 1 diabetes do if an insulin reaction is experienced while at a basketball game?

• A. Call your parents immediately.
• B. Buy a soda and hamburger to eat.
• C. Administer insulin as soon as possible.
• D. Leave the arena and rest until the symptoms subside.

Correct answer: B

Rationale: Choosing option B, 'Buy a soda and hamburger to eat,' is the most appropriate action for an adolescent with type 1 diabetes experiencing an insulin reaction during a basketball game. In this situation, the individual is likely experiencing hypoglycemia, and consuming a soda provides a quick source of sugar to raise blood glucose levels rapidly. The hamburger can offer a more sustained release of energy due to its protein and fat content. Option A is incorrect because while contacting parents for help may be necessary in some situations, immediate action to address hypoglycemia is crucial. Option C is incorrect because administering insulin would further lower blood sugar levels, worsening the condition. Option D is incorrect as leaving the arena without addressing the hypoglycemia can lead to a worsening of symptoms and potentially dangerous outcomes.

2. At 0345, you receive a call for a woman in labor. Upon arriving at the scene, you are greeted by a very anxious man who tells you that his wife is having her baby 'now.' This man escorts you into the living room where a 25-year-old woman is lying on the couch in obvious pain. After determining that delivery is not imminent, you begin transport. While en route, the mother tells you that she feels the urge to push. You assess her and see the top of the baby's head bulging from the vagina. What is your most appropriate first action?

• A. Allow the head to deliver and check for the location of the cord.
• B. Advise your partner to stop the ambulance and assist with the delivery.
• C. Tell the mother to take short, quick breaths until you arrive at the hospital.
• D. Prepare the mother for an emergency delivery and open the obstetrics kit.

Correct answer: B

Rationale: In this scenario, the most appropriate first action is to advise your partner to stop the ambulance and assist with the delivery. When the baby's head is visible and delivery is imminent, it is crucial to provide immediate assistance to ensure the safety of both the mother and the baby. Allowing the head to deliver and checking for the location of the cord (Choice A) may delay necessary actions during an imminent delivery. Instructing the mother to take short, quick breaths (Choice C) is not suitable as active delivery is already in progress. Preparing the mother for an emergency delivery and opening the obstetrics kit (Choice D) is not the most immediate action needed when the baby's head is already visible and delivery is imminent.

3. A healthcare provider is discussing the care of an infant with colic with the parents. What should the healthcare provider explain is the cause of colicky behavior?

• A. Inadequate peristalsis
• B. Paroxysmal abdominal pain
• C. An allergic response to certain proteins in milk
• D. A protective mechanism designed to eliminate foreign proteins

Correct answer: B

Rationale: Colicky behavior in infants is primarily characterized by paroxysmal abdominal pain, resulting in excessive crying and fussiness. The pain episodes are often unpredictable and can be distressing for both the infant and the parents. Inadequate peristalsis (Choice A) refers to weak or ineffective bowel movements and is not the typical cause of colic. While some infants may experience colic due to an allergic response to certain proteins in milk (Choice C), this is not the primary cause of colic behavior in all infants. Choice D, a protective mechanism designed to eliminate foreign proteins, is not a recognized cause of colic. Therefore, the correct explanation for the cause of colicky behavior in infants is paroxysmal abdominal pain.

4. When developing the plan of care for a child with burns requiring fluid replacement therapy, what information would the nurse expect to include?

• A. Administration of colloid initially followed by a crystalloid
• B. Determination of fluid replacement based on the type of burn
• C. Administration of most of the volume during the first 8 hours
• D. Monitoring of hourly urine output to achieve less than 1 mL/kg/hr

Correct answer: C

Rationale: The correct answer is C. In fluid replacement therapy for burns, it is crucial to administer most of the volume during the first 8 hours to prevent shock and maintain perfusion. This rapid administration is essential to stabilize the child's condition. Choices A and B are incorrect because the initial fluid replacement in burns typically involves administering crystalloids, not colloids, and the fluid replacement is generally calculated based on the extent of the burn injury, not the type of burn. Choice D is incorrect as monitoring hourly urine output to achieve less than 1 mL/kg/hr is not recommended in burn patients; instead, urine output should be monitored to achieve 1-2 mL/kg/hr in children to ensure adequate renal perfusion.

5. A home care nurse is visiting a family for the first time. The 4-week-old infant had surgery for exstrophy of the bladder and creation of an ileal conduit soon after birth. When the nurse arrives, the mother appears tired, and the baby is crying. After an introduction, which is the most appropriate statement by the nurse?

• A. “Tell me about your daily routine.”
• B. “You look tired. Is everything all right?”
• C. “When was the last time the baby had a bottle?”
• D. “Oh, it looks like you two are having a bad day.”

Correct answer: A

Rationale: The most appropriate statement by the nurse in this scenario is to inquire about the family's daily routine. This question allows the nurse to gather information about the family dynamics, the care routine for the infant post-surgery, feeding schedules, and potential stressors. It opens the conversation in a non-intrusive manner and helps the nurse assess the family's situation to provide appropriate support. Choices B, C, and D do not address the situation effectively. Asking about the daily routine is crucial for the nurse to understand the family's needs and offer targeted assistance.

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