Nursing Elites

1. A caregiver is seeking guidance from a healthcare provider concerning a child diagnosed with impetigo. Which of the following instructions should the healthcare provider include?

• A. Apply warm compresses to the affected area.
• B. Keep the child home from school until lesions are crusted over.
• C. Apply antibiotic ointment to the lesions.
• D. Cleanse the affected area with hydrogen peroxide.

Correct answer: C

Rationale: The healthcare provider should recommend applying antibiotic ointment to the lesions to prevent the spread of infection and facilitate healing. Antibiotic ointment helps combat the bacterial infection associated with impetigo and supports the skin's recovery process. This approach aids in reducing symptoms, preventing complications, and promoting a quicker resolution of the condition.

2. The healthcare provider is assessing an infant brought to the clinic due to diarrhea. The infant is alert but has dry mucous membranes. Which additional assessment data indicates to the healthcare provider that the infant is experiencing an early to moderate stage of dehydration?

• A. Bradycardia
• B. Tachycardia
• C. Increased blood pressure
• D. Normal fontanels

Correct answer: B

Rationale: Tachycardia is a common early sign of dehydration in infants, especially when presenting with dry mucous membranes and diarrhea. The increased heart rate is the body's compensatory mechanism to maintain cardiac output in response to dehydration. Bradycardia, increased blood pressure, and normal fontanels are not typically associated with early to moderate dehydration in infants.

3. A patient in the emergency department reports taking sildenafil (Viagra) and nitroglycerin 1 hr before sexual activity. Which finding should the nurse immediately report to the physician?

• A. WBC of 3200 cells/mm³
• B. RR of 26 breaths/min
• C. Temp of 38°C
• D. BP of 70/50

Correct answer: D

Rationale: The correct answer is D: BP of 70/50. When sildenafil (Viagra) is taken with nitroglycerin, it can cause severe hypotension that is unresponsive to treatment. The combination of these medications can lead to a dangerous drop in blood pressure. It is crucial to immediately report hypotension in this scenario as it poses a significant risk to the patient's life. It is recommended to allow at least 24 hours to elapse between the last dose of sildenafil and nitroglycerin to prevent such adverse effects. The other vital signs and lab values may be abnormal but do not have the immediate life-threatening implications that severe hypotension does in this context.

4. The healthcare provider is caring for a 9-month-old infant who just returned from the postanesthesia care unit (PACU) after a shunt placement for hydrocephalus. Which healthcare provider prescription should the nurse question?

• A. Vital signs and neurologic checks hourly
• B. Small, frequent formula feedings
• C. Elevate the head of the bed
• D. Daily head circumference measurements

Correct answer: C

Rationale: Elevating the head of the bed in a child with hydrocephalus can potentially increase intracranial pressure. This can be counterproductive and may lead to complications after shunt placement surgery. Keeping the head of the bed flat or slightly elevated is often recommended to optimize cerebral perfusion and reduce the risk of increased intracranial pressure.

5. When a patient is taking glucocorticoids and digoxin, which electrolyte should the nurse prioritize monitoring?

• A. Calcium
• B. Magnesium
• C. Sodium
• D. Potassium

Correct answer: D

Rationale: The nurse should primarily monitor potassium levels in a patient taking glucocorticoids and digoxin. Glucocorticoids can lead to potassium loss, potentially increasing the risk of digoxin toxicity. Additionally, glucocorticoids may worsen hypokalemia induced by diuretics like thiazides and loops. While calcium, magnesium, and sodium are important electrolytes to monitor in various clinical situations, they are not the priority in this specific scenario of a patient on glucocorticoids and digoxin.

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