Nursing Elites

1. A 5-year-old child is admitted to the pediatric unit with fever and pain secondary to a sickle cell crisis. Which intervention should the nurse implement first?

• A. Obtain a culture of any sputum or wound drainage
• B. Initiate normal saline IV at 50 ml/hr
• C. Administer a loading dose of penicillin IM
• D. Administer the initial dose of folic acid PO

Correct answer: B

Rationale: In a child with a sickle cell crisis, the priority intervention is to initiate normal saline IV at 50 ml/hr to manage dehydration and help alleviate pain. This intervention helps improve hydration status and supports the circulation of sickled red blood cells, reducing the risk of vaso-occlusive episodes and associated pain. Obtaining a culture of any sputum or wound drainage (Choice A) may be necessary but is not the initial priority. Administering a loading dose of penicillin IM (Choice C) is important but not the first intervention. Administering the initial dose of folic acid PO (Choice D) is beneficial but does not address the immediate need for hydration in a sickle cell crisis.

2. In which chromosome pattern is Duchenne disease inherited?

• A. Autosomal dominant
• B. Autosomal recessive
• C. X-linked recessive
• D. Mitochondrial

Correct answer: C

Rationale: Duchenne disease is caused by a mutation in the DMD gene located on the X chromosome, leading to an X-linked recessive inheritance pattern. Males are typically affected by this disorder as they have only one X chromosome, while females are carriers with one normal and one affected X chromosome.

3. A client who is 32 weeks' gestation comes to the women's health clinic and reports nausea and vomiting. On examination, the nurse notes that the client has an elevated blood pressure. Which action should the nurse implement next?

• A. Inspect the client's face for edema.
• B. Ascertain the frequency of headaches.
• C. Evaluate for a history of cluster headaches.
• D. Observe and time the client's contractions.

Correct answer: A

Rationale: Inspecting the client's face for edema is crucial to assess for preeclampsia, a serious condition characterized by high blood pressure during pregnancy. Edema, particularly facial edema, can be a significant indicator of preeclampsia, prompting the need for further evaluation and management to ensure the well-being of both the client and the unborn child.

4. The healthcare provider is preparing to administer phytonadione to a newborn. Which statement made by the parents indicates understanding why the healthcare provider is administering this medication?

• A. Prevent hemorrhagic disorders.
• B. Help an immature liver.
• C. Improve insufficient dietary intake.
• D. Stimulate the immune system.

Correct answer: A

Rationale: The correct answer is A: 'Prevent hemorrhagic disorders.' Phytonadione (vitamin K) is administered to newborns to prevent hemorrhagic disease by promoting blood clotting. Newborns are born with low levels of vitamin K, which is essential for blood clotting, hence the administration to prevent hemorrhagic disorders. Choice B is incorrect because phytonadione is not given to help an immature liver but to supply vitamin K. Choice C is incorrect as phytonadione is not administered to improve dietary intake but to provide essential vitamin K. Choice D is incorrect as phytonadione does not stimulate the immune system but helps with blood clotting.

5. What action should be implemented when preparing to measure the fundal height of a pregnant client?

• A. Have the client empty her bladder.
• B. Request the client lie on her left side.
• C. Perform Leopold's maneuvers first.
• D. Give the client some cold juice to drink.

Correct answer: A

Rationale: The correct action when preparing to measure the fundal height of a pregnant client is to have the client empty her bladder. This is essential to ensure an accurate measurement because a full bladder can displace the uterus and affect the accuracy of the assessment. Choice B is incorrect because the client should lie flat on her back, not on her left side, to measure fundal height accurately. Choice C is incorrect because Leopold's maneuvers are used to determine the position of the fetus, not to measure fundal height. Choice D is incorrect as giving the client cold juice is not necessary for measuring fundal height.

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