Nursing Elites

1. When discussing the child's wishes for future care, it is important for the nurse to first identify what the child knows about the disease and his prognosis. Factors such as the perceived severity of the illness will be significant in planning for end-of-life care. If the child does not understand the disease process or prognosis, the plan of care would not be effective or realistic. In addition, asking a child about desired interventions in the event of cardiac or respiratory arrest would not be an appropriate initial area of questioning. If the child does not understand the disease process, these questions may seem frightening or threatening. While exploring the child's belief about death would be important, it would not be the initial area of discussion and should be guided by the child rather than the nurse.

• A. What the child knows about the disease and his prognosis.
• B. How the child would like to handle the plan of care.
• C. What interventions the child would like in the event of cardiac or respiratory arrest.
• D. What the child believes about death.

Correct answer: A

Rationale: When discussing the child's wishes for future care, it is essential to first determine what the child understands about the disease and his prognosis. This information is crucial for planning appropriate end-of-life care. If the child lacks comprehension of the illness and its prognosis, any care plan discussed would be ineffective and unrealistic. Inquiring about desired interventions during cardiac or respiratory arrest is not the initial step, as it may cause distress if the child lacks understanding. While exploring the child's beliefs about death is significant, it should not be the primary focus initially and should be approached based on the child's readiness, not the nurse's agenda. Therefore, the correct first step is to assess what the child knows about the disease and his prognosis.

2. A nurse reviews the health history of a client who will be seeing the health care provider to obtain a prescription for a combination oral contraceptive (estrogen and progestin). Which finding in the health history would cause the nurse to determine that the use of a combination oral contraceptive is contraindicated?

• A. The client has type 2 diabetes mellitus.
• B. The client is being treated for hypertension.
• C. The client has been treated for breast cancer.
• D. The client has hyperlipidemia.

Correct answer: C

Rationale: The correct answer is that the client has been treated for breast cancer. Combination oral contraceptives containing estrogen and progestin are contraindicated for women with a history of certain conditions, such as thrombophlebitis, thromboembolic disorders, cerebrovascular disease, coronary artery disease, myocardial infarction, known or suspected breast cancer, known or suspected estrogen-dependent neoplasm, benign or malignant liver tumors, and undiagnosed abnormal genital bleeding. Although having type 2 diabetes mellitus, being treated for hypertension, or having hyperlipidemia are risk factors that require caution when using combination oral contraceptives, they are not absolute contraindications like a history of breast cancer.

3. The client with a history of advanced chronic obstructive pulmonary disease (COPD) had conventional gallbladder surgery 2 days previously. Which intervention has priority for preventing respiratory complications?

• A. Incentive spirometry every 1 to 2 hours.
• B. Coughing and deep breathing every 1 to 2 hours.
• C. Getting the client out of bed 4 times daily as ordered by the physician.
• D. Giving oxygen at 4 L/minute according to the physician's order.

Correct answer: C

Rationale: The priority intervention for preventing respiratory complications in a client with advanced COPD who underwent gallbladder surgery is to get the client out of bed 4 times daily. This helps prevent pooling of secretions in the lungs and promotes better lung expansion. Incentive spirometry, coughing, and deep breathing are essential interventions; however, they should be performed more frequently, ideally every 1 to 2 hours, rather than every 4 hours or 4 times daily. Giving oxygen at 4 L/minute could potentially decrease the client's respiratory drive, which is not the priority in this case.

4. Which of the following infant behaviors demonstrates the concept of object permanence?

• A. The infant cries when his mother leaves the room.
• B. The infant looks at the floor to find a toy that he was playing with and dropped.
• C. The infant picks up another toy after the one he was playing with rolls under the couch.
• D. The infant participates in a game of patty-cake.

Correct answer: B

Rationale: Object permanence occurs when the infant learns that something or someone still exists even though they might not be able to see it or them. This typically develops between 9 and 10 months of age. The correct answer, 'The infant looks at the floor to find a toy that he was playing with and dropped,' demonstrates object permanence as the infant understands that the toy still exists even though it is temporarily out of sight. Choices A and C do not directly relate to object permanence as the behaviors described do not necessarily indicate an understanding of objects existing when out of sight. Choice D is incorrect as participating in a game of patty-cake does not involve demonstrating object permanence. Peek-a-boo is a more suitable example of a game that demonstrates object permanence, as the infant continues to look for the hidden face, understanding that it still exists even though temporarily unseen.

5. In a client with asthma who develops respiratory acidosis, what should the nurse expect the client's serum potassium level to be?

• A. normal
• B. elevated
• C. low
• D. unrelated to the pH

Correct answer: B

Rationale: In respiratory acidosis, the serum potassium level is expected to be elevated. This occurs because potassium shifts from cells into the bloodstream as a compensatory mechanism to maintain acid-base balance. Choices A, C, and D are incorrect. A normal potassium level is not expected in respiratory acidosis. A low potassium level is more commonly associated with alkalosis, not acidosis. The potassium level is indeed related to pH changes in respiratory acidosis, leading to the expected elevation.

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