Nursing Elites

1. When assessing a child with suspected nephrotic syndrome, what clinical manifestation is the nurse likely to observe?

• A. Jaundice
• B. Edema
• C. Hypertension
• D. Polyuria

Correct answer: B

Rationale: Edema is a hallmark clinical manifestation of nephrotic syndrome. In nephrotic syndrome, there is increased glomerular permeability leading to the loss of proteins, particularly albumin, in the urine. This results in decreased oncotic pressure, leading to fluid shifting into the interstitial spaces and causing edema. Jaundice (Choice A) is not a typical clinical manifestation of nephrotic syndrome. Hypertension (Choice C) is more commonly associated with conditions like glomerulonephritis. Polyuria (Choice D) is not a primary symptom of nephrotic syndrome; instead, patients may have reduced urine output due to fluid retention from edema.

2. Congenital heart defects have traditionally been divided into acyanotic or cyanotic defects. Based on the nurse’s knowledge of congenital heart defects, this system in clinical practice is

• A. helpful because it explains the hemodynamics involved
• B. helpful because children with cyanotic defects are easily identified
• C. problematic because cyanosis is rarely present in children
• D. problematic because children with acyanotic heart defects may develop cyanosis

Correct answer: D

Rationale: The classification system of congenital heart defects into acyanotic or cyanotic defects is problematic because children with acyanotic heart defects may develop cyanosis, complicating the differentiation. Cyanosis can occur in some acyanotic defects due to various reasons such as right-to-left shunting or decreased pulmonary blood flow, making the classification based solely on cyanosis misleading. Choice A is incorrect because while the classification may involve hemodynamics, the main issue lies in the potential for acyanotic defects to develop cyanosis. Choice B is incorrect as the ease of identifying children with cyanotic defects does not address the main problem with the classification system. Choice C is also incorrect as the presence of cyanosis is not the only factor determining the classification's validity.

3. A group of nursing students is reviewing the components of the endocrine system. The students demonstrate understanding of the review when they identify what as the primary function of this system?

• A. Regulation of water balance
• B. Hormonal secretion
• C. Cellular metabolism
• D. Growth stimulation

Correct answer: B

Rationale: The correct answer is 'Hormonal secretion' (Choice B). The primary function of the endocrine system is to secrete hormones that regulate various bodily functions such as metabolism, growth, and reproduction. Choice A, 'Regulation of water balance,' is primarily controlled by the kidneys and the urinary system, not the endocrine system. Choice C, 'Cellular metabolism,' is more directly related to the functions of individual cells rather than the overall function of the endocrine system. Choice D, 'Growth stimulation,' is a function that can be influenced by hormones secreted by the endocrine system, but it is not the primary function of the system.

4. A 4-year-old child is brought to the emergency department with a suspected fracture. What is the priority nursing action?

• A. Immobilize the affected limb
• B. Apply ice to the affected area
• C. Elevate the affected limb
• D. Check the child's neurovascular status

Correct answer: A

Rationale: The priority nursing action when a child with a suspected fracture is brought to the emergency department is to immobilize the affected limb. Immobilization helps prevent further injury until a fracture is confirmed or ruled out. Applying ice or elevating the limb can wait until after immobilization has been achieved. Checking the child's neurovascular status is important but is not the priority action in this situation.

5. The nurse notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of

• A. poor appetite
• B. increased potassium intake
• C. reduction of edema
• D. restriction to bed rest

Correct answer: C

Rationale: The correct answer is C: reduction of edema. In acute glomerulonephritis, weight loss is often a result of the reduction of edema. Acute glomerulonephritis causes fluid retention and edema due to kidney inflammation. As the inflammation resolves with treatment, the kidneys can excrete excess fluid, leading to weight loss. Choices A, B, and D are incorrect. Poor appetite, increased potassium intake, and restriction to bed rest are not typically the primary reasons for weight loss in acute glomerulonephritis.

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