Nursing Elites

1. A child is admitted in acute renal failure (ARF). Therapeutic management to rapidly provoke a flow of urine includes the administration of what medication?

• A. Propranolol (Inderal)
• B. Calcium gluconate
• C. Mannitol (Osmitrol) or furosemide (Lasix)
• D. Sodium, chloride, and potassium

Correct answer: C

Rationale: Mannitol and furosemide are diuretics commonly used to induce diuresis in acute renal failure, helping to provoke urine flow and manage fluid overload. Calcium gluconate and electrolyte supplementation are used for other specific conditions and not primarily for diuresis.

2. Which congenital heart defect causes a "boot-shaped" heart on a chest x-ray?

• A. Tetralogy of Fallot
• B. Coarctation of the aorta
• C. Transposition of the great arteries
• D. Ventricular septal defect

Correct answer: A

Rationale: The correct answer is A: Tetralogy of Fallot. Tetralogy of Fallot, a congenital heart defect with four distinct abnormalities, often presents with a "boot-shaped" heart on chest x-ray due to right ventricular hypertrophy. This characteristic finding is due to the specific combination of defects in this condition. Coarctation of the aorta (choice B), Transposition of the great arteries (choice C), and Ventricular septal defect (choice D) do not typically result in a "boot-shaped" heart on a chest x-ray like Tetralogy of Fallot does.

3. Which one of the following strategies might be recommended for an infant with failure to thrive (FTT) to increase caloric intake?

• A. Vary the schedule for routine activities on a daily basis.
• B. Be persistent through 10 to 15 minutes of food refusal.
• C. Avoid solids until after the bottle is well accepted.
• D. Use developmental stimulation by a specialist during feedings.

Correct answer: B

Rationale: Being persistent through 10 to 15 minutes of food refusal is recommended to help increase caloric intake in infants with FTT. Establishing a routine and using developmental stimulation can also be helpful, but the priority is ensuring adequate caloric intake.

4. An effective means of establishing rapport with the hospitalized pre-schooler is through:

• A. Lengthy discussion
• B. Explanation with drawings and models
• C. Play
• D. Silence

Correct answer: C

Rationale: Play is an effective way to communicate and build rapport with young children, especially pre-schoolers. It helps them feel comfortable, express themselves, and establish a connection with the caregiver. Lengthy discussions may not be suitable for their age and attention span, while explanation with drawings and models can enhance communication but may not engage them as effectively as play. Silence, on the other hand, may create a sense of unease or lack of interaction for pre-schoolers.

5. What information does the nurse include when teaching parents about nonpharmacologic strategies for pain management in children?

• A. May reduce pain perception.
• B. Make pharmacologic strategies unnecessary.
• C. Usually take too long to implement.
• D. Trick children into believing they do not have pain.

Correct answer: A

Rationale: The correct answer is A: 'May reduce pain perception.' When teaching parents about nonpharmacologic strategies for pain management in children, the nurse should include information that these techniques may help reduce pain perception, make the pain more tolerable, decrease anxiety, and enhance the effectiveness of analgesics. It is important to note that nonpharmacologic techniques should be learned before the pain occurs, and it is beneficial to use both pharmacologic and nonpharmacologic measures for pain control. Choice B is incorrect because nonpharmacologic strategies do not make pharmacologic strategies unnecessary but rather complement them. Choice C is incorrect as nonpharmacologic techniques, when properly learned and applied, do not usually take too long to implement. Choice D is incorrect as the goal of nonpharmacologic strategies is not to trick children into believing they do not have pain, but to help them cope with and manage their pain effectively.

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