Nursing Elites

1. Which of the following statements regarding two-rescuer child CPR is correct?

• A. The chest should be compressed with one hand, and a compression-to-ventilation ratio of 30:2 should be delivered.
• B. A compression-to-ventilation ratio of 15:2 should be delivered with pauses in compressions to give ventilations.
• C. The chest should be allowed to fully recoil between compressions to optimize venous return.
• D. Compress the chest with one or two hands to a depth equal to one third the diameter of the chest.

Correct answer: D

Rationale: In two-rescuer child CPR, the correct compression depth is one third the diameter of the chest. This depth can be achieved by compressing the chest with one or two hands. It is crucial to follow the correct compression depth guideline to ensure effective chest compressions and circulation during CPR for a child.

2. When ventilating an apneic 3-year-old child with a bag-valve mask device, what is the MOST important action to take?

• A. Avoid hyperventilation and ensure adequate chest rise.
• B. Squeeze the bag with both hands and use a pediatric mask.
• C. Immediately insert an oropharyngeal airway.
• D. Provide one breath every 3 to 5 seconds.

Correct answer: A

Rationale: When ventilating an apneic child, the most important action is to avoid hyperventilation and ensure adequate chest rise. Hyperventilation can lead to decreased cardiac output and increased intracranial pressure. Adequate chest rise confirms effective ventilation and minimizes the risk of complications. Choice B is incorrect because using both hands to squeeze the bag may not ensure proper ventilation and can lead to complications. Choice C is incorrect as inserting an oropharyngeal airway is not the initial action in ventilating an apneic child with a bag-valve mask. Choice D is incorrect as providing ventilations every 3 to 5 seconds may not be appropriate for effective ventilation in a pediatric patient.

3. The nurse is preparing new parents for discharge with their newborn. The father asks the nurse why the baby's head is so pointed and puffy-looking. What is the best response by the nurse?

• A. His head is molded from fitting through the birth canal. It will become more round.
• B. We refer to that as 'cone head,' which is a temporary condition that goes away.
• C. It might mean that your baby sustained brain damage during birth, and could have delays.
• D. I think he looks just like you. Your head is much the same shape as your baby's.

Correct answer: A

Rationale: The corrected response 'His head is molded from fitting through the birth canal. It will become more round.' is the best answer as it explains the physiological reason for the baby's appearance after birth. It reassures the father that the pointed and puffy-looking head is a normal part of the birthing process and will resolve on its own. Choice B is incorrect because while 'cone head' is a term used colloquially, it does not provide a detailed explanation. Choice C is incorrect and should be avoided as it introduces unnecessary worry by suggesting brain damage. Choice D is not an appropriate response as it doesn't address the father's concern or provide accurate information about newborn physiology.

4. A child newly diagnosed with diabetes mellitus has been stabilized with insulin injections daily. A nurse prepares a discharge teaching plan regarding the insulin. The teaching plan should reinforce which of the following concepts?

• A. Always store insulin vials in the refrigerator
• B. Adjust insulin dosage before exercise
• C. Presence of ketones in urine indicates a need for less insulin
• D. Systematically rotate injection sites

Correct answer: D

Rationale: Systematically rotating injection sites is crucial to prevent tissue damage and ensure optimal insulin absorption. This practice helps in preventing lipohypertrophy, a condition characterized by fat accumulation at injection sites, which can affect insulin absorption and lead to inconsistent blood glucose control. By rotating injection sites, the risk of skin and tissue damage is minimized, and insulin's effectiveness is maintained over time.

5. Following an apparent febrile seizure, a 4-year-old boy is alert and crying. His skin is hot and moist. Appropriate treatment for this child includes:

• A. allowing the parents to transport the child.
• B. offering oxygen and providing transport.
• C. rapidly cooling the child in cold water.
• D. keeping the child warm and providing transport.

Correct answer: B

Rationale: After a febrile seizure, it is important to offer oxygen and provide transport to a medical facility for further evaluation and management of the underlying cause. Oxygen may be needed in case of hypoxemia resulting from the seizure. Rapidly cooling the child in cold water is not recommended as it may lead to complications such as hypothermia. Keeping the child warm is also not advisable as the priority is to prevent hyperthermia and provide necessary medical intervention by healthcare providers.

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