Nursing Elites

1. A child is admitted with renal failure. Which of these findings should the nurse expect?

• A. Decreased BUN
• B. Azotemia and oliguria
• C. Increased glomerular filtration rate (GFR)
• D. Polyuria and elevated creatinine clearance

Correct answer: B

Rationale: Azotemia (elevated BUN and creatinine) and oliguria (reduced urine output) are classic signs of renal failure, indicating impaired kidney function. In renal failure, the kidneys are unable to effectively filter waste products, leading to an increase in BUN and creatinine levels in the blood. Additionally, oliguria occurs due to decreased kidney function. Increased GFR (Choice C) is not expected in renal failure as it signifies improved kidney function, which is not the case in renal failure. Polyuria and elevated creatinine clearance (Choice D) are not typical findings in renal failure. Polyuria is more commonly associated with conditions like diabetes insipidus, while elevated creatinine clearance would indicate increased kidney function, which is contrary to the impaired function seen in renal failure.

2. The nurse is preparing a child for possible alopecia from chemotherapy. What information should the nurse give regarding alopecia?

• A. Hair usually regrows in two years.
• B. When hair regrows, it may have a slightly different color or texture.
• C. Expose your head to sunlight to minimize alopecia.
• D. Wearing hats and scarves are preferred to wearing a wig.

Correct answer: B

Rationale: The correct answer is B. Hair loss from chemotherapy is usually temporary, and when it regrows, it may have a different color or texture. Sun exposure should be minimized, as the scalp may be more sensitive. Wearing hats and scarves can provide comfort and protection, but there is no preference over wearing a wig. Choice A is incorrect because hair regrowth after chemotherapy varies from person to person and usually occurs sooner than two years. Choice C is incorrect as sun exposure should be minimized to protect the sensitive scalp. Choice D is incorrect as the preference between wearing hats, scarves, or a wig is subjective and depends on the individual's comfort and preferences.

3. Which is the single most important factor to consider when communicating with children?

• A. Presence of the child's parent
• B. Child’s physical condition
• C. Child’s developmental level
• D. Child’s nonverbal behaviors

Correct answer: C

Rationale: The child’s developmental level is the most important factor, as it determines how information should be communicated and what the child can understand.

4. What disease should be suspected in a 3-day-old infant presenting with abdominal distention, vomiting, and failure to pass meconium?

• A. Pyloric stenosis
• B. Intussusception
• C. Hirschsprung disease
• D. Celiac disease

Correct answer: C

Rationale: Hirschsprung disease should be suspected in a newborn with abdominal distention, vomiting, and failure to pass meconium. This condition arises from a congenital absence of nerve cells in a portion of the colon, leading to severe constipation and intestinal obstruction. Pyloric stenosis typically presents with non-bilious projectile vomiting in the first few weeks of life. Intussusception classically manifests with sudden onset of colicky abdominal pain and currant jelly stools. Celiac disease may present with chronic diarrhea, failure to thrive, and abdominal distention but is less likely in this scenario.

5. The nurse is admitting a child with severe isotonic dehydration. Which intravenous fluid should the nurse anticipate the doctor to order initially to replace fluids?

• A. 0.9% normal saline
• B. D5 0.2% (1/4) normal saline
• C. D5W
• D. Albumin

Correct answer: A

Rationale: In the case of severe isotonic dehydration, the initial fluid of choice is 0.9% normal saline. This solution is preferred because it helps to restore both fluids and electrolytes effectively. Options B, C, and D are not suitable for the initial management of severe isotonic dehydration. D5 0.2% (1/4) normal saline (Choice B) is a hypotonic solution and might worsen the imbalance. D5W (Choice C) is a hypotonic solution that does not contain electrolytes essential for rehydration. Albumin (Choice D) is a colloid solution used for specific indications like hypoproteinemia or hypoalbuminemia, not for initial rehydration in severe dehydration.

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