Nursing Elites

1. A child is being assessed for acute poststreptococcal glomerulonephritis (APSGN). Which of the following findings should the nurse expect?

• A. Hematuria
• B. Polyuria
• C. Hypertension
• D. Diarrhea

Correct answer: C

Rationale: In acute poststreptococcal glomerulonephritis (APSGN), hypertension is a common finding due to fluid retention and decreased kidney function. This condition often presents with hypertension as a result of sodium and water retention, as well as reduced glomerular filtration rate. Hematuria, not diarrhea, is also a common symptom of APSGN due to inflammation and damage to the glomeruli. Polyuria, an increase in urine output, is not a typical finding in APSGN unless severe kidney damage leads to decreased urine concentrating ability.

2. When receiving change-of-shift report for children, which child should the nurse assess first?

• A. A toddler who has a concussion and an episode of forceful vomiting
• B. An adolescent with infective endocarditis who reports having a headache
• C. An adolescent who was placed into Halo traction 1 hour ago and rates his pain at a 6 on a 0-10 scale
• D. A school-age child with acute glomerulonephritis and brown-colored urine

Correct answer: A

Rationale: The nurse should assess the toddler with a concussion and an episode of forceful vomiting first when receiving change-of-shift report for children. Forceful vomiting in a toddler with a concussion indicates increased intracranial pressure, requiring immediate assessment and intervention to prevent further complications.

3. Which statement best reflects a top-down approach to the evaluation process?

• A. OT focuses on evaluating the child's poor performance in hand skills
• B. OT conducts an assessment to determine a motor age for fine motor and gross motor skills
• C. OT initiates by interviewing the family about routines, interests, and daily habits
• D. OT starts by assessing muscle tone, postural control, and range of motion

Correct answer: C

Rationale: A top-down evaluation approach in occupational therapy begins with understanding the child's daily life, family routines, interests, and habits to ensure that the therapy provided is relevant and meaningful within the child's natural environment. By initiating the evaluation process with family interviews to gather contextual information, the occupational therapist gains a comprehensive view of the child's life, which allows for a more holistic and client-centered approach. Choice A focuses solely on the child's poor performance in hand skills, which is more characteristic of a bottom-up approach. Choice B mentions determining a motor age, which is not necessarily aligned with a top-down assessment. Choice D emphasizes physical assessments like muscle tone and range of motion, which are important but do not capture the essence of a top-down approach that considers the child's environment and routines.

4. A school-age child has peripheral edema. Which of the following assessments should the nurse perform to confirm peripheral edema?

• A. Palpate the dorsum of the child's feet
• B. Weigh the child daily using the same scale
• C. Assess the child's skin turgor
• D. Observe the child for periorbital swelling

Correct answer: A

Rationale: To confirm peripheral edema in a child, the nurse should palpate the dorsum of the child's feet by pressing a fingertip against a bony prominence for 5 seconds. This assessment helps detect the presence of pitting edema, which is characterized by an indentation that remains after the pressure is released.

5.

• A. Have you noticed any swelling in your feet?
• B. Are you having vivid dreams or hallucination?
• C. Have you noticed any changes in your stool?
• D. Have you had your flu vaccine?

Correct answer: B

Rationale: Patients taking levodopa/carbidopa (Sinemet) are at increased risk for the psychiatric side effects of levodopa, including visual hallucinations, vivid dreams, nightmares, and paranoid ideation. The other questions are not directly related to problems that are likely to occur with this drug.

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