Nursing Elites

1. A mother brings her child to the well-child clinic and expresses concern to the nurse because the child has been playing with another child diagnosed with hepatitis. The nurse prepares to perform an assessment on the child, knowing that which finding would be of least concern for hepatitis?

• A. Jaundice
• B. Hepatomegaly
• C. Dark-colored, frothy urine
• D. Left upper abdominal quadrant pain

Correct answer: D

Rationale: Assessment findings in a child with hepatitis typically include right upper quadrant tenderness and hepatomegaly. The child may also present with pale, clay-colored stools and dark, frothy urine. Jaundice, which can be observed in the sclerae, nail beds, and mucous membranes, is a common sign of hepatitis. Left upper abdominal quadrant pain is not a typical finding associated with hepatitis; therefore, it would be of least concern in this scenario. The other options are more commonly associated with hepatitis and are important signs to monitor for in a child with possible exposure to the virus.

2. In children suspected to have a diagnosis of diabetes, which one of the following complaints would be most likely to prompt parents to take their school-age child for evaluation?

• A. Polyphagia
• B. Dehydration
• C. Bedwetting
• D. Weight loss

Correct answer: C

Rationale: The correct answer is 'Bedwetting.' One of the initial symptoms of type 1 diabetes in children is bedwetting. Parents are likely to notice bedwetting in a school-age child, prompting them to seek evaluation. Polyphagia (excessive hunger) and weight loss are also common symptoms of diabetes but may not be as readily noticeable to parents compared to bedwetting. Dehydration is a consequence of diabetes rather than an early symptom that would prompt parents for evaluation.

3. A patient with right lower-lobe pneumonia has been treated with IV antibiotics for 3 days. Which assessment data obtained by the nurse indicates that the treatment has been effective?

• A. Bronchial breath sounds are heard at the right base.
• B. The patient coughs up small amounts of green mucus.
• C. The patients white blood cell (WBC) count is 9000/L
• D. Increased tactile fremitus is palpable over the right chest

Correct answer: C

Rationale: The normal WBC count indicates that the antibiotics have been effective. All the other data suggest that a change in treatment is needed.

4. Which clinical manifestations are recognized in nephrotic syndrome?

• A. Hematuria, bacteriuria, weight gain
• B. Gross hematuria, albuminuria, fever
• C. Hypertension, weight loss, proteinuria
• D. Massive proteinuria, hypoalbuminemia, edema

Correct answer: D

Rationale: Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, and edema. In this syndrome, there is loss of proteins, particularly albumin, in the urine leading to hypoalbuminemia, fluid retention, and subsequent edema. This results in elevated lipid levels like hypercholesterolemia, but not hypertension. Therefore, choices A, B, and C are incorrect. Hematuria, bacteriuria, fever, and weight loss are not typically associated with nephrotic syndrome, distinguishing it from other kidney disorders.

5. A patient is being admitted to the ICU with a severe case of encephalitis. Which of these drugs would the nurse not expect to be prescribed for this condition?

• A. Acyclovir (Zovirax)
• B. Mannitol (Osmitrol)
• C. Lactated Ringer's
• D. Phenytoin (Dilantin)

Correct answer: C

Rationale: In the treatment of encephalitis, medications like Acyclovir and Phenytoin are commonly prescribed. Acyclovir is an antiviral medication used to treat viral infections like herpes simplex virus, which can cause encephalitis. Phenytoin is an antiepileptic drug that may be used to manage seizures associated with encephalitis. Mannitol is a diuretic used to reduce intracranial pressure (ICP) by decreasing cerebral edema. Lactated Ringer's solution, on the other hand, is primarily used in fluid replacement therapy and may not be indicated if a patient is at risk for high ICP, as excessive fluid administration could worsen cerebral edema and increase ICP.

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