Nursing Elites

1. A healthcare professional is reviewing the clinical records of infants and children with cardiac disorders who developed heart failure. What did the healthcare professional determine is the last sign of heart failure?

• A. Tachypnea
• B. Tachycardia
• C. Peripheral edema
• D. Periorbital edema

Correct answer: C

Rationale: Peripheral edema is often the last sign of heart failure in infants and children as it indicates significant fluid retention and circulatory compromise. Tachypnea (Choice A) and tachycardia (Choice B) are early signs of heart failure due to the body's compensatory mechanisms. Periorbital edema (Choice D) can occur in heart failure but is not typically the last sign; it is more commonly associated with renal or hepatic dysfunction.

2. A nurse is caring for an infant with phenylketonuria (PKU). What diet should the nurse anticipate will be ordered by the healthcare provider?

• A. Fat-free
• B. Protein-enriched
• C. Phenylalanine-free
• D. Low-phenylalanine

Correct answer: D

Rationale: A low-phenylalanine diet is necessary for infants with PKU because it helps prevent the accumulation of phenylalanine, which can result in brain damage. Fat-free (Choice A) and protein-enriched (Choice B) diets are not specifically indicated for PKU. While phenylalanine-free (Choice C) may seem logical, complete elimination of phenylalanine is not practical or safe as it is an essential amino acid. Therefore, the correct choice is a low-phenylalanine diet, which restricts phenylalanine intake to a safe level.

3. Which cardiac defects are associated with tetralogy of Fallot?

• A. Right ventricular hypertrophy, atrial and ventricular defects, and mitral valve stenosis
• B. Origin of the aorta from the right ventricle and of the pulmonary artery from the left ventricle
• C. Right ventricular hypertrophy, ventricular septal defect, pulmonic stenosis, and overriding aorta
• D. Altered connection between the pulmonary artery and the aorta, right ventricular hypertrophy, and an atrial septal defect

Correct answer: C

Rationale: Tetralogy of Fallot is characterized by a combination of four specific cardiac defects: right ventricular hypertrophy, ventricular septal defect, pulmonic stenosis, and overriding aorta. Choice A is incorrect as it includes mitral valve stenosis, which is not typically part of tetralogy of Fallot. Choice B describes transposition of the great arteries rather than tetralogy of Fallot. Choice D includes an atrial septal defect, which is not part of the classic presentation of tetralogy of Fallot.

4. 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.

5. What is important to include in discharge instructions for parents of a child who has had a tonsillectomy?

• A. Encourage the child to gargle with salt water
• B. Encourage fluid intake
• C. Provide the child with hard candy
• D. Apply heat to the neck

Correct answer: B

Rationale: Encouraging fluid intake is essential in the discharge instructions for a child who has had a tonsillectomy. It helps keep the throat moist, aids in preventing dehydration, and promotes healing. Gargling with salt water is not typically recommended after a tonsillectomy as it may irritate the surgical site. Providing the child with hard candy is not advisable as it can irritate the throat and potentially cause harm. Applying heat to the neck is also not recommended post-tonsillectomy as it can increase swelling and discomfort in the surgical area.

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