Nursing Elites

1. A child is suspected of suffering from intussusception. The nurse should be alert to which clinical manifestation of this condition?

• A. Tender, distended abdomen
• B. Presence of fecal incontinence
• C. Incomplete development of the anus
• D. Infrequent and difficult passage of dry stools

Correct answer: A

Rationale: Intussusception is an invagination of a section of the intestine into the distal bowel, and it is the most common cause of bowel obstruction in children aged 3 months to 6 years. A tender, distended abdomen is a typical clinical manifestation of intussusception. The presence of fecal incontinence is not a characteristic presentation of intussusception; it describes encopresis, which generally affects preschool and school-aged children but is not specific to intussusception. Incomplete development of the anus describes imperforate anus, a disorder diagnosed in the neonatal period, not intussusception. The infrequent and difficult passage of dry stools is characteristic of constipation, a common issue in children that can occur at any age, although it often peaks at 2 to 3 years old.

2. A mother brings her 5-week-old infant to the health care clinic and tells the nurse that the child has been vomiting after meals. The mother reports that the vomiting is becoming more frequent and forceful. The nurse suspects pyloric stenosis and asks the mother which assessment question to elicit data specific to this condition?

• A. Are the stools ribbon-like, and is the infant eating poorly?
• B. Does the infant suddenly become pale, begin to cry, and draw the legs up to the chest?
• C. Does the vomit contain sour, undigested food without bile, and is the infant constipated?
• D. Does the infant cry loudly and continuously during the evening hours but nurses or takes formula well?

Correct answer: C

Rationale: Vomiting undigested food that is not bile stained and constipation are classic symptoms of pyloric stenosis. Stools that are ribbon-like and a child who is eating poorly are signs of congenital megacolon (Hirschsprung's disease). An infant who suddenly becomes pale, cries out, and draws the legs up to the chest is demonstrating physical signs of intussusception. Crying during the evening hours, appearing to be in pain, eating well, and gaining weight are clinical manifestations of colic.

3. After an endoscopic procedure with general anesthesia, what is a priority nursing consideration for a patient in the day surgery center?

• A. Raise the siderails of the patient's bed
• B. Do not offer fluids, food, or any oral intake
• C. Check the temperature of the patient
• D. Teach the patient to avoid aspirin or NSAIDS

Correct answer: B

Rationale: After an endoscopic procedure with general anesthesia, the priority nursing consideration is to not offer fluids, food, or any oral intake to the patient. Endoscopies involve passing a tube through the mouth into the esophagus or upper GI. Anesthesia is often given to inactivate the gag reflex, making the patient vulnerable to aspiration. Raising the siderails of the patient's bed is important for safety but not the immediate priority. Checking the patient's temperature may be important but is not the priority immediately after the procedure. Teaching the patient to avoid aspirin or NSAIDS is important for post-procedure care but is not the priority immediately after the endoscopic procedure.

4. A patient has just been admitted with probable bacterial pneumonia and sepsis. Which order should the nurse implement first?

• A. Performing a chest x-ray via stretcher
• B. Obtaining blood cultures from two sites
• C. Administering Ciprofloxacin (Cipro) 400 mg IV
• D. Inserting an Acetaminophen (Tylenol) rectal suppository

Correct answer: B

Rationale: In a patient with probable bacterial pneumonia and sepsis, the priority intervention is to obtain blood cultures from two sites before initiating antibiotic therapy. This is crucial to identify the causative organism and guide appropriate antibiotic treatment. Administering antibiotics without obtaining cultures first can interfere with accurate results. Performing a chest x-ray and administering acetaminophen can be done after obtaining blood cultures as they are important but not as urgent as identifying the causative organism in sepsis.

5. The nurse reviews the record of a child who is suspected to have glomerulonephritis. Which statement by the child's parent should the nurse expect that is associated with this diagnosis?

• A. ''His pediatrician said his kidneys are working well.''
• B. ''I noticed his urine was the color of cola lately.''
• C. ''I'm so glad they didn't find any protein in his urine.''
• D. ''The nurse who admitted my child said his blood pressure was low.''

Correct answer: B

Rationale: Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Gross hematuria, resulting in dark, smoky, cola-colored, or brown-colored urine, is a classic symptom of glomerulonephritis. Blood urea nitrogen levels and serum creatinine levels may be elevated, indicating that kidney function is compromised. A mild to moderate elevation in protein in the urine is associated with glomerulonephritis. Hypertension is also common because of fluid volume overload secondary to the kidneys not working properly. Therefore, the parent's statement about noticing cola-colored urine aligns with the expected symptom in glomerulonephritis. The other options are less indicative of glomerulonephritis: choice A indicates normal kidney function, choice C mentions absence of protein in the urine (which is not expected in glomerulonephritis), and choice D talks about low blood pressure (hypertension is more common in glomerulonephritis).

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