Nursing Elites

1. Which statement by a school-aged client going to summer camp indicates the best understanding of the mode of transmission of Lyme disease?

• A. I'll cover my mouth with a wet cloth if there's too much dust blowing.
• B. Cuts and scrapes need to be washed out and covered right away.
• C. I'm not going to swim where the water is standing still or feels too hot.
• D. I have to wear long sleeves and pants when we're hiking around the pond.

Correct answer: D

Rationale: The correct answer is D. Wearing long sleeves and pants is an effective measure to prevent tick bites, which can transmit Lyme disease. Ticks are commonly found in wooded areas and tall grass, so covering exposed skin helps reduce the risk of tick bites and subsequently lowers the risk of contracting Lyme disease. Choices A, B, and C do not directly address the mode of transmission of Lyme disease. Option A pertains to respiratory protection against dust, Option B focuses on wound care, and Option C relates to water safety, none of which are directly related to preventing Lyme disease transmission.

2. A 13-year-old client with type 1 diabetes presents to the clinic with a blood glucose level of 400 mg/dL. The client reports feeling thirsty and having frequent urination. What is the nurse’s priority action?

• A. Administer insulin as prescribed
• B. Encourage the client to drink water
• C. Check the client’s urine for ketones
• D. Reinforce the importance of diet and exercise

Correct answer: A

Rationale: In a client with type 1 diabetes presenting with hyperglycemia (blood glucose level of 400 mg/dL) and symptoms of thirst and frequent urination, the priority action for the nurse is to administer insulin as prescribed. Insulin helps lower the blood glucose level and prevents complications like diabetic ketoacidosis. While encouraging hydration is essential, administering insulin is crucial to address the high blood glucose levels. Checking urine for ketones is important in diabetic management but is secondary to administering insulin in this scenario. Reinforcing diet and exercise importance is vital for diabetes management but not the priority in acute hyperglycemia.

3. A 9-year-old child is brought to the clinic with a fever, rash, and swollen joints. The nurse notes that the child had a sore throat two weeks ago that was not treated. What condition should the nurse suspect?

• A. Scarlet fever
• B. Rheumatic fever
• C. Kawasaki disease
• D. Juvenile rheumatoid arthritis

Correct answer: B

Rationale: In this scenario, the child's symptoms of fever, rash, and swollen joints following an untreated sore throat two weeks ago are indicative of rheumatic fever. Rheumatic fever can develop as a complication of untreated streptococcal infections, leading to systemic inflammation and affecting various organs, including the joints. This condition manifests with symptoms such as fever, rash, and swollen joints, aligning with the child's presentation in this case. Scarlet fever typically presents with a sandpapery rash and strawberry tongue but does not involve joint inflammation. Kawasaki disease presents with fever, rash, and mucous membrane changes but does not typically involve joint swelling. Juvenile rheumatoid arthritis can cause joint swelling but is not directly linked to a recent untreated sore throat.

4. The mother of a 9-month-old, diagnosed with respiratory syncytial virus (RSV) yesterday, calls the clinic to inquire if it will be all right to take her infant to the first birthday party of a friend's child the following day. What response should the nurse provide this mother?

• A. The child will no longer be contagious, so no need to take any further precautions.
• B. Ensure there are no children under the age of 6 months around the infected child.
• C. The child can be around other children but should wear a mask at all times.
• D. Do not expose other children to RSV. It is highly contagious even without direct contact.

Correct answer: D

Rationale: The correct answer is D. RSV is highly contagious, even without direct contact. It is important to prevent the spread of the virus to other children, so the infected child should not attend the birthday party to avoid exposing other children to RSV. This is crucial to protect the health of other children who may be more vulnerable to the virus. Choices A, B, and C are incorrect. Choice A is incorrect as RSV remains contagious for a period of time, and precautions should be taken to prevent its spread. Choice B is incorrect because the age limit specified is not a reliable measure to prevent transmission. Choice C is incorrect as wearing a mask may not be sufficient to prevent the spread of RSV in a social setting like a birthday party.

5. A 5-year-old child is brought to the emergency department with severe abdominal pain and vomiting. The child’s parent reports that the pain started suddenly and is located in the lower right abdomen. What should the nurse do first?

• A. Administer pain medication
• B. Notify the healthcare provider immediately
• C. Start an IV line for fluid administration
• D. Obtain a complete blood count

Correct answer: B

Rationale: The correct answer is to notify the healthcare provider immediately. The child's presentation of sudden, severe abdominal pain in the lower right abdomen is highly concerning for appendicitis, a medical emergency. Promptly notifying the healthcare provider is crucial for further evaluation and management. Administering pain medication as the first action might mask symptoms and delay diagnosis. Starting an IV line for fluid administration and obtaining a complete blood count are important interventions but should come after healthcare provider notification.

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