A 16-year-old female student with a history of asthma controlled with both an oral antihistamine and an albuterol (Proventil) metered-dose inhaler (MDI) comes to the school nurse. The student complains that she cannot sleep at night, feels shaky and her heart feels like it is 'beating a mile a minute.' Which information is most important for the nurse to obtain?

Correct Answer: D

Rationale: The most important information for the nurse to obtain in this scenario is how often the MDI is used daily. This is crucial to assess if the symptoms the student is experiencing, such as insomnia, shakiness, and tachycardia, could be related to overuse of the inhaler. Overuse of albuterol can lead to side effects like tremors, palpitations, and difficulty sleeping, so understanding the frequency of MDI use is key in determining a potential cause for the student's symptoms.

Correct Answer: C

Rationale: In pediatric nursing, assessing breath sounds in a crying 18-month-old child requires a strategic approach for accurate evaluation. Option C, allowing the child to play with a stethoscope to distract them during auscultation, is the correct choice. This option promotes a child-friendly environment, reducing anxiety and facilitating a more cooperative assessment. Engaging the child in a non-threatening activity maintains their attention and minimizes resistance, leading to a more accurate evaluation of breath sounds. Option A, documenting unavailability due to crying, is incorrect as it does not address the need for an assessment. Option B, asking the caregiver to quiet the child, may not always be feasible and can lead to increased stress for both the child and caregiver. Option D, auscultating and documenting breath sounds while noting the child was crying, may yield inaccurate results due to the child's distress affecting the breath sounds. Educationally, this rationale highlights the importance of child-centered care in pediatric assessments. It emphasizes the significance of creating a comfortable and engaging environment to ensure accurate evaluations while considering the developmental stage and emotional state of the child. By choosing option C, healthcare professionals can effectively assess breath sounds while promoting a positive experience for the child and caregiver.

Correct Answer: A

Rationale: In a 10-year-old with newly diagnosed osteomyelitis, the most important information for the nurse to obtain is the recent history of infection recurrences. This is crucial because osteomyelitis is an infection of the bone, and assessing for any recent recurrence of infections can help in determining the possible source of the osteomyelitis and guide the treatment plan accordingly.

Correct Answer: C

Rationale: In this scenario, the correct action for the nurse to implement when the infusion of chemotherapy via an implanted medication port is complete for a 16-year-old with acute myelocytic leukemia at the outpatient oncology clinic is to flush the mediport with saline and heparin solution (Option C). This is crucial to maintain the patency and prevent clot formation in the implanted port. Flushing the mediport with saline and heparin solution helps to ensure that the port remains clear of any residual chemotherapy agents, preventing potential complications such as occlusion or infection. It also helps maintain the integrity of the port for future use, ensuring optimal delivery of medications. Administering Zofran (Option A) may be indicated for preventing nausea and vomiting associated with chemotherapy, but it is not the immediate priority once the infusion is complete. Obtaining blood samples for RBCs, WBCs, and platelets (Option B) is important but is not the immediate action required post-infusion. Initiating an infusion of normal saline (Option D) is not necessary at this point unless specifically prescribed for hydration or other reasons. Educationally, understanding the importance of proper mediport care and maintenance is essential for pediatric nurses caring for oncology patients. It ensures safe and effective delivery of chemotherapy and other medications, minimizing complications and optimizing outcomes for these vulnerable patients.