Nursing Elites

1. Your assessment of a 5-year-old child reveals that he is unresponsive with a respiratory rate of 8 breaths/min and a heart rate of 50 beats/min. Treatment for this child should include:

• A. high-flow oxygen via non-rebreathing mask and rapid transport.
• B. assisted ventilation with a bag-mask device and rapid transport.
• C. positive-pressure ventilation, chest compressions, and rapid transport.
• D. back slaps and chest thrusts while attempting artificial ventilations.

Correct answer: C

Rationale: In a 5-year-old child who is unresponsive with severe bradycardia and bradypnea, the priority is to provide positive-pressure ventilation to support breathing and perform chest compressions to support circulation. This child is in cardiac arrest, and the recommended treatment according to pediatric basic life support guidelines involves a combination of positive-pressure ventilation and chest compressions to maintain oxygenation and circulation. Rapid transport to a medical facility for further advanced care is crucial in this critical situation. Choices A, B, and D are incorrect because high-flow oxygen via non-rebreathing mask, assisted ventilation with a bag-mask device, and back slaps with chest thrusts are not sufficient in a cardiac arrest situation where the child requires immediate positive-pressure ventilation and chest compressions to maintain oxygenation and circulation.

2. A 3-year-old child has a sudden onset of respiratory distress. The mother denies any recent illnesses or fever. You should suspect:

• A. croup.
• B. foreign body airway obstruction.
• C. lower respiratory infection.
• D. epiglottitis.

Correct answer: B

Rationale: In a 3-year-old child with a sudden onset of respiratory distress and no recent illnesses or fever, the likely cause is a foreign body airway obstruction. Foreign body obstruction can lead to sudden respiratory distress without other preceding symptoms. It is crucial to consider this possibility and act promptly to clear the airway in such cases to prevent serious complications.

3. When you attempt to assess a 22-year-old woman who has been sexually assaulted, she orders you not to touch her. Your MOST appropriate initial action should be to:

• A. obtain a signed refusal and return to service.
• B. transport the patient without performing an assessment.
• C. explain to the patient that she must be examined.
• D. ask a female EMT to attempt to assess the patient.

Correct answer: D

Rationale: In cases of sexual assault, it's important to respect the patient's wishes and provide a female EMT to attempt the assessment if the patient prefers.

4. A mother of a 2-year-old child complains that her child has a fever, sore mouth, and red eye. What will be the possible diagnosis?

• A. TB
• B. Meningitis
• C. Measles
• D. Pertussis

Correct answer: C

Rationale: The correct answer is C, Measles. Measles commonly presents with symptoms such as fever, sore mouth, and red eyes. These characteristic symptoms help differentiate measles from the other conditions listed. Tuberculosis (Choice A) typically presents with respiratory symptoms, Meningitis (Choice B) commonly presents with symptoms like headache, neck stiffness, and altered mental status, while Pertussis (Choice D) is characterized by severe coughing spells. Therefore, in this case, the symptoms described align more closely with measles.

5. What is the most important intervention to decrease the stressors of hospitalization for a 9-month-old infant being treated for a bacterial infection?

• A. Encourage the infant's parents to remain at the bedside and actively participate in the infant's care.
• B. Provide a brightly lit environment for the infant.
• C. Play tapes of the mother's voice.
• D. Assign the same nurse to the infant as much as possible.

Correct answer: A

Rationale: Encouraging the infant's parents to remain at the bedside and actively participate in the infant's care is crucial in decreasing the stressors of hospitalization for the infant. Parental presence provides comfort and security, promotes bonding, and maintains a sense of familiarity for the infant during a potentially stressful situation. This involvement can help reduce anxiety and promote better outcomes for the infant's emotional well-being and overall hospital experience. Providing a brightly lit environment (choice B) can actually increase stress for the infant, as infants generally prefer dimly lit environments for better sleep. Playing tapes of the mother's voice (choice C) may offer some comfort but does not substitute for parental presence. While assigning the same nurse to the infant (choice D) can provide continuity of care, it is not as effective as having the parents present for emotional support and bonding.

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