Nursing Elites

1. You are dispatched to a residence for a 4-year-old female who is sick. Your assessment reveals that she has increased work of breathing and is making a high-pitched sound during inhalation. Her mother tells you that she has been running a high fever for the past 24 hours. Your MOST immediate concern should be:

• A. determining if the child has a history of croup.
• B. preparing to treat her for a febrile seizure.
• C. assessing the need for ventilation assistance.
• D. taking her temperature to see how high it is.

Correct answer: C

Rationale: In a child with increased work of breathing, a high-pitched sound during inhalation, and a high fever, upper airway obstruction should be suspected. The child's condition may require immediate ventilation assistance to ensure adequate oxygenation and ventilation. Therefore, the most immediate concern in this scenario is to assess the need for ventilation assistance.

2. What is the MOST effective way to prevent cardiopulmonary arrest in a newborn?

• A. Ensure effective oxygenation and ventilation.
• B. Administer blow-by oxygen as soon as the newborn is born.
• C. Perform an Apgar assessment every 5 minutes.
• D. Suction the newborn's mouth and nose every 3 minutes.

Correct answer: A

Rationale: The most effective way to prevent cardiopulmonary arrest in a newborn is to ensure effective oxygenation and ventilation. This is crucial in maintaining adequate oxygen supply and preventing respiratory distress or failure, which are significant factors leading to cardiopulmonary arrest. Providing appropriate ventilation support and oxygenation can help sustain the newborn's vital functions and reduce the risk of cardiopulmonary compromise.

3. A female child, age 2, is brought to the emergency department after ingesting an unknown number of aspirin tablets about 30 minutes earlier. Her father is blaming the mother for neglecting the child while she was cooking. On entering the examination room, the child is crying and clinging to the mother. Which data should the nurse obtain first?

• A. Heart rate, respiratory rate, and blood pressure
• B. Recent exposure to communicable diseases
• C. Number of immunizations received
• D. Height and weight

Correct answer: A

Rationale: In this scenario, the priority is to assess the child's vital signs first, including heart rate, respiratory rate, and blood pressure. These data will provide critical information on the child's current physiological status and guide further interventions. Option B, recent exposure to communicable diseases, is not the priority in an acute ingestion situation. Option C, number of immunizations received, and option D, height and weight, are important but not as critical as assessing vital signs in this immediate situation.

4. A 3-year-old boy is found to be in cardiopulmonary arrest. As you begin one-rescuer CPR, your partner prepares the AED. What is the appropriate compression to ventilation ratio for this child?

• A. 3:01
• B. 30:2
• C. 15:2
• D. 5:1

Correct answer: B

Rationale: The correct compression to ventilation ratio for a single rescuer performing CPR on a child is 30:2. This ratio ensures adequate circulation and oxygenation during CPR. 30 compressions help maintain blood flow, while 2 rescue breaths provide oxygenation. Choice A (3:01) is incorrect as it does not follow the standard CPR guidelines for children. Choice C (15:2) is incorrect as it is the ratio used for adult CPR. Choice D (5:1) is incorrect as it is not the recommended ratio for child CPR.

5. Which of the following is the MOST detrimental effect of gastric distention in infants and children?

• A. Tracheal rupture.
• B. Less effective chest compressions.
• C. Decreased ventilatory volume.
• D. Acute rupture of the diaphragm.

Correct answer: C

Rationale: Gastric distention in infants and children can lead to a decrease in ventilatory volume. This occurs because the distended stomach can limit the movement of the diaphragm, reducing its ability to contract and expand the chest cavity effectively. As a result, the amount of air entering and leaving the lungs is decreased, impacting ventilation. Tracheal rupture, acute rupture of the diaphragm, and less effective chest compressions are not typically associated with gastric distention.

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