Nursing Elites

1. A nurse in an emergency department is caring for a school-age child who is experiencing an anaphylactic reaction. Which of the following is the priority action by the nurse?

• A. Elevate the head of the child's bed
• B. Insert a large-bore IV catheter for the child
• C. Determine the allergen that caused the child's reaction
• D. Administer IM epinephrine to the child

Correct answer: D

Rationale: In the management of anaphylaxis, the priority action for the nurse is to administer IM epinephrine to the child. Epinephrine is the first-line treatment for anaphylaxis as it helps reverse the severe manifestations of the reaction by constricting blood vessels, relaxing airway muscles, and decreasing hives and swelling. Elevating the head of the child's bed may be beneficial for respiratory distress but is not the priority over administering epinephrine. Inserting a large-bore IV catheter may be necessary for fluid resuscitation but is not the initial priority. Identifying the allergen is important for prevention and future management but is not the immediate action needed in the acute phase of an anaphylactic reaction.

2. A healthcare professional is reviewing the laboratory report of an infant who is receiving treatment for severe dehydration. The professional should identify which of the following laboratory values indicates effectiveness of the current treatment?

• A. Potassium 2.9 mEq/L
• B. Sodium 140 mEq/L
• C. Urine specific gravity 1.035
• D. BUN 25 mg/dL

Correct answer: B

Rationale: A sodium level of 140 mEq/L within the expected reference range indicates effective treatment for dehydration. In dehydration, sodium levels are often elevated, so a normal sodium level suggests that the treatment is helping to restore the electrolyte balance in the infant's body.

3. During a physical assessment of a hospitalized 5-year-old child, the healthcare provider notes that the foreskin has been retracted and is very tight on the shaft of the penis; they are unable to return it over the head of the penis. What action should the healthcare provider implement?

• A. Forcibly push the foreskin down over the head of the penis.
• B. Place a warm compress on the penis.
• C. Notify the healthcare provider in charge.
• D. Wait a few hours and try again.

Correct answer: C

Rationale: The correct action is to notify the healthcare provider in charge of this occurrence of paraphimosis. Paraphimosis is a urologic emergency where the foreskin is retracted and becomes tight, potentially impeding blood flow to the penis. It is crucial to seek medical intervention promptly to prevent complications.

4. Which statement by an 18-year-old woman vaccinated with Gardasil indicates that more teaching is necessary?

• A. This vaccination will cure the HPV infection I got when I was 16.
• B. I will still need to have a routine Pap screen performed.
• C. Gardasil can prevent genital warts in males and females.
• D. This drug does not protect against all types of HPV.

Correct answer: A

Rationale: The correct answer is A because Gardasil does not cure existing HPV infections. Gardasil is a preventive vaccine and does not treat existing infections. Choice B is correct as regular Pap screenings are still necessary even after vaccination. Choice C is also correct as Gardasil can prevent genital warts. Choice D is correct as Gardasil does not protect against all types of HPV. Therefore, option A is the statement that indicates the need for more teaching.

5. A patient is prescribed Lisinopril as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug?

• A. Weight gain of 5 pounds in 1 week
• B. Potassium level of 3.5mEq/L
• C. Crackles in the lungs are no longer heard
• D. Jugular vein distention

Correct answer: C

Rationale: The correct answer is C. Lisinopril, an ACE inhibitor, promotes venous dilation, which helps reduce pulmonary congestion and peripheral edema. The absence of previously heard crackles in the lungs indicates effectiveness in reducing pulmonary congestion. Edema and jugular vein distention are signs of heart failure and would not indicate the therapeutic effect of Lisinopril. A potassium level of 3.5mEq/L is within the normal range and not directly related to the therapeutic effect of Lisinopril.

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