Nursing Elites

1. Which strategy is most likely to promote positive behavior in children?

• A. Providing flexible instructions with no consequences
• B. Limiting opportunities until the child performs adequately
• C. Improving the child's competence and creating a positive environment
• D. Setting strict rules with punishments for misbehavior

Correct answer: C

Rationale: Improving the child's competence and creating a positive environment is the most effective strategy to promote positive behavior in children. This approach focuses on enhancing the child's skills and abilities while fostering a supportive and encouraging atmosphere. By empowering the child and surrounding them with positivity, they are more likely to exhibit positive behaviors as they feel competent, valued, and motivated. This strategy emphasizes support and reinforcement over punitive measures, leading to long-lasting behavioral improvements.

2. A healthcare provider is planning care for a child with hyperkalemia. Which manifestation associated with the documented hyperkalemia requires immediate intervention by the healthcare provider?

• A. Hyperthermia
• B. Respiratory distress
• C. Seizures
• D. Cardiac arrhythmias

Correct answer: D

Rationale: In hyperkalemia, cardiac arrhythmias are the most critical and life-threatening manifestation that requires immediate intervention. Hyperkalemia can lead to dangerous heart rhythm disturbances, potentially resulting in cardiac arrest. Prompt treatment is essential to stabilize the heart rhythm and prevent life-threatening complications. Hyperthermia, respiratory distress, and seizures are not typically associated with hyperkalemia and should be addressed, but cardiac arrhythmias pose the most urgent risk to the patient's life.

3. During a vaso-occlusive crisis in sickle cell anemia, what action is crucial for a nurse to take?

• A. Administer meperidine for pain.
• B. Apply cold compresses to the child's joints.
• C. Limit the child's fluid intake.
• D. Maintain bed rest for the child.

Correct answer: D

Rationale: During a vaso-occlusive crisis in sickle cell anemia, maintaining bed rest is crucial to reduce oxygen consumption and alleviate pain. Movement can worsen the crisis by increasing sickling of red blood cells, leading to further tissue damage and pain. Bed rest helps to improve blood flow, reduce pain, and promote healing. Administering meperidine for pain (Choice A) is not recommended due to the risk of normeperidine accumulation and potential neurotoxicity. Applying cold compresses (Choice B) may cause vasoconstriction, worsening the vaso-occlusive crisis. Limiting fluid intake (Choice C) is not appropriate as adequate hydration is essential to prevent dehydration and maintain blood flow.

4. A parent of a child with oral candidiasis is being taught by a nurse. Which statement by the parent indicates an understanding of the teaching?

• A. I will boil the nipples and pacifiers for 20 minutes each day.
• B. I will stop the medication as soon as the spots disappear.
• C. I will apply an over-the-counter steroid cream to the spots.
• D. I will mix the medication in my child's bottle.

Correct answer: A

Rationale: Boiling the nipples and pacifiers for 20 minutes each day is an appropriate measure to prevent reinfection of oral candidiasis. This practice helps eliminate the Candida fungus from these items, reducing the risk of the child getting reinfected. It is crucial for the parent to follow this hygienic practice consistently to ensure the child's recovery and prevent the spread of the infection.

5. The nurse is providing care for a pediatric client in the emergency department (ED) with a diagnosis of decreased level of consciousness (LOC) secondary to increased intracranial pressure (ICP). Which healthcare provider order should the nurse question?

• A. Passive range-of-motion exercises to promote hip flexion
• B. Oxygen at 2 L nasal cannula to maintain saturation above 95%
• C. Hourly vital signs and neurologic checks
• D. Elevate head of bed 30 degrees

Correct answer: A

Rationale: In a pediatric client with increased intracranial pressure (ICP) and decreased level of consciousness (LOC), passive range-of-motion exercises to promote hip flexion should be questioned as they can potentially increase intracranial pressure. This action may not be safe for the client's condition. The other options are appropriate interventions for managing a pediatric client with increased ICP and decreased LOC.

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