Nursing Elites

1. A child is hospitalized in acute renal failure and has a serum potassium greater than 7 mEq/L. What temporary measures that will produce a rapid but transient effect to reduce the potassium should the nurse expect to be prescribed? (Select all that apply.)

• A. Dialysis
• B. All below
• C. Sodium bicarbonate
• D. Glucose 50% and insulin

Correct answer: A

Rationale: Calcium gluconate, sodium bicarbonate, and glucose with insulin are used as temporary measures to rapidly reduce serum potassium levels. They help shift potassium into cells and stabilize the heart but do not remove potassium from the body like dialysis does.

2. A school-age child with cancer is being prepared for a procedure. The child says, “I have had one of these before. They hurt.” The nurse bases her response on what knowledge related to pain in this patient?

• A. Often misrepresent experiencing pain
• B. Tolerate pain better than adults
• C. Become accustomed to painful procedures
• D. Commonly experience treatment-related moderate to severe pain when they have cancer

Correct answer: D

Rationale: The correct answer is D. Pain is frequently reported by children with cancer, with around 84% experiencing it. Most children report moderate to severe pain, with about half finding it highly distressing. There is no evidence to suggest that children often misrepresent their pain experiences. Pain tolerance is not solely based on age but is a complex phenomenon. Children do not become accustomed to painful procedures, as each experience of pain is unique.

3. The nurse is assisting a child with celiac disease to select foods from a menu. What foods should the nurse suggest?

• A. Hamburger patty with no bun
• B. Spaghetti with marinara sauce
• C. Corn on the cob with butter
• D. Rice cakes with hummus

Correct answer: C

Rationale: The correct answer is C: Corn on the cob with butter. Corn is a gluten-free option suitable for children with celiac disease. Choice A is incorrect because the bun contains gluten, so suggesting a hamburger patty without the bun is a better option. Choice B is not ideal as spaghetti often contains gluten, but spaghetti with marinara sauce could be a safer choice if the spaghetti is gluten-free. Choice D, rice cakes with hummus, is a gluten-free alternative, but corn on the cob is a more straightforward and common choice for children.

4. Chemicals, agents, or factors that cause physical defects in the developing embryo and are most harmful during organogenesis are:

• A. Teratogens
• B. Heterozygous
• C. Inborn errors
• D. Multifactorial

Correct answer: A

Rationale: Teratogens are substances that can cause congenital abnormalities, especially during the first trimester when organogenesis occurs. Choice A, Teratogens, is the correct answer as it specifically refers to substances that cause physical defects in the developing embryo. Choices B, Heterozygous, C, Inborn errors, and D, Multifactorial, are incorrect as they do not directly relate to substances that cause physical defects in embryos during organogenesis.

5. The nurse is caring for a child receiving chemotherapy with the following orders: Zantac 70 mg IV in normal saline 30 mL to infuse over 30 minutes. The nurse should set the infusion pump to deliver how many mL/hour?

• A. 60 mL/hour
• B. 45 mL/hour
• C. 30 mL/hour
• D. 15 mL/hour

Correct answer: A

Rationale: The correct answer is A: 60 mL/hour. The total volume to be infused is 30 mL over 30 minutes. To calculate the infusion rate in mL/hour, divide the total volume by the total time in hours. In this case, 30 mL / 0.5 hours = 60 mL/hour. Choice B, 45 mL/hour, is incorrect as it does not correspond to the calculated infusion rate. Choices C and D, 30 mL/hour and 15 mL/hour respectively, are also incorrect based on the calculation.

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