Nursing Elites

1. A 24-year-old female contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, what would serologic testing most likely reveal?

• A. antibody to hepatitis D (anti-HDV).
• B. hepatitis B surface antigen (HBsAg).
• C. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG).
• D. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM).

Correct answer: D

Rationale: Hepatitis A is primarily transmitted through the oral-fecal route. During the acute phase of hepatitis A, serologic testing typically reveals anti-hepatitis A virus immunoglobulin M (anti-HAV IgM). This antibody appears early in the course of the infection. The presence of anti-HAV IgM indicates an acute infection with hepatitis A. Choices A and B are incorrect as hepatitis D and hepatitis B antigens are not typically associated with acute hepatitis A. Choice C, anti-hepatitis A virus immunoglobulin G (anti-HAV IgG), would indicate a past infection and lifelong immunity, which is not expected during the acute phase of the illness.

2. A 4-year-old hospitalized child begins to have a seizure while playing with hard plastic toys in the hallway. Of the following nursing actions, which one should the nurse do first?

• A. Place the child in the nearest bed
• B. Administer IV medication to slow down the seizure
• C. Place a padded tongue blade in the child's mouth
• D. Remove the child's toys from the immediate area

Correct answer: D

Rationale: During a seizure, the priority nursing actions are to ensure the safety of the child and maintain airway patency. Placing objects in the child's mouth, like a padded tongue blade, is not recommended as it can lead to injury or obstruction of the airway. Moving the child to a bed is also not the immediate priority during a seizure. Administering IV medication to slow down the seizure is not typically done as the initial action. Therefore, the correct first nursing action is to remove any potential hazards, such as the hard plastic toys, from the immediate area to prevent injury during the seizure.

3. Which of the following conditions most commonly causes acute glomerulonephritis?

• A. A congenital condition leading to renal dysfunction.
• B. Prior infection with group A Streptococcus within the past 10-14 days.
• C. Viral infection of the glomeruli.
• D. Nephrotic syndrome.

Correct answer: B

Rationale: Acute glomerulonephritis is most commonly caused by the immune response to a prior upper respiratory infection with group A Streptococcus. Glomerular inflammation occurs about 10-14 days after the infection, resulting in scant, dark urine and retention of body fluid. Periorbital edema and hypertension are common signs at diagnosis.

4. A child has just been diagnosed with juvenile idiopathic arthritis. Which of the following statements about the disease is most accurate?

• A. The child has a poor chance of recovery without joint deformity.
• B. Most children progress to adult rheumatoid arthritis.
• C. Nonsteroidal anti-inflammatory drugs are the first choice in treatment.
• D. Physical activity should be minimized.

Correct answer: C

Rationale: The correct answer is that nonsteroidal anti-inflammatory drugs are the first choice in treatment for juvenile idiopathic arthritis (formerly known as juvenile rheumatoid arthritis). NSAIDs are important as a first-line treatment and typically require 3-4 weeks for the therapeutic anti-inflammatory effects to be realized. Choice A is incorrect as early treatment can improve outcomes and prevent joint deformities. Choice B is incorrect as juvenile idiopathic arthritis does not necessarily progress to adult rheumatoid arthritis. Choice D is incorrect as physical activity should be encouraged in children with arthritis to maintain joint mobility and overall health.

5. A client is seen for testing to rule out Rocky Mountain Spotted Fever. Which of the following signs or symptoms is associated with this condition?

• A. Fever and rash
• B. Circumoral cyanosis
• C. Elevated glucose levels
• D. All of the above

Correct answer: A

Rationale: The correct answer is 'Fever and rash.' Rocky Mountain Spotted Fever (RMSP) is caused by the R. rickettsii pathogen, which damages blood vessels. Patients with RMSP typically present with fever, edema, and a rash that initially appears on the hands and feet before spreading across the body. The disease manifests following a tick bite. Choice A is correct as fever and rash are key indicators of RMSP. Circumoral cyanosis (choice B) is not typically associated with RMSP; it refers to a bluish discoloration around the mouth and is more indicative of oxygen deprivation. Elevated glucose levels (choice C) are not specific signs of RMSP. Therefore, choice D, 'All of the above,' is incorrect since only choice A, 'Fever and rash,' is associated with Rocky Mountain Spotted Fever.

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