Nursing Elites

1. A parent asks the nurse what would be the first indication that acute glomerulonephritis was improving. What would be the nurse's best response?

• A. Blood pressure will stabilize.
• B. Your child will have more energy.
• C. Urine will be free of protein.
• D. Urine output will increase.

Correct answer: D

Rationale: Increased urine output is often the first sign that acute glomerulonephritis is improving, as it indicates a reduction in fluid retention and better kidney function. Stabilization of blood pressure and other symptoms typically follow.

2. An intravenous line is needed in a school-age child. What medication is an appropriate analgesic for use with this patient?

• A. TAC (tetracaine, epinephrine [Adrenalin], cocaine) 15 minutes before the procedure.
• B. A transdermal fentanyl (Duragesic) patch at the site of venipuncture.
• C. EMLA (eutectic mixture of local anesthetics) immediately before the procedure.
• D. LMX (4% liposomal lidocaine cream) 30 minutes before the procedure.

Correct answer: D

Rationale: LMX is an effective analgesic agent when applied to the skin 30 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. TAC provides skin anesthesia about 15 minutes after application to nonintact skin, making it more suitable for wound suturing. Transdermal fentanyl patches are designed for continuous pain control, not rapid pain control needed for a procedure like venipuncture. EMLA, for maximum effectiveness, must be applied approximately 60 minutes before the procedure, making it less suitable for immediate pain relief required for intravenous line placement.

3. When auscultating an infant's lungs, the nurse detects diminished breath sounds. What should the nurse interpret this as?

• A. Suggestive of chronic pulmonary disease
• B. Suggestive of impending respiratory failure
• C. An abnormal finding warranting investigation
• D. A normal finding in infants younger than 1 year of age

Correct answer: C

Rationale: Diminished breath sounds in an infant are an abnormal finding and warrant further investigation to rule out conditions like atelectasis or pneumonia.

4. An adolescent patient wants to make decisions about treatment options, along with his parents. Which moral value is the nurse displaying when supporting the adolescent to make decisions?

• A. Justice
• B. Autonomy
• C. Beneficence
• D. Nonmaleficence

Correct answer: B

Rationale: Supporting an adolescent in making decisions about their care reflects the moral value of autonomy, emphasizing the importance of respecting the patient's right to make informed choices.

5. A child is admitted with acute glomerulonephritis. What should the nurse expect the urinalysis during this acute phase to show?

• A. Bacteriuria and hematuria
• B. Hematuria and proteinuria
• C. Bacteriuria and increased specific gravity
• D. Proteinuria and decreased specific gravity

Correct answer: B

Rationale: Hematuria (blood in the urine) and proteinuria (protein in the urine) are common findings in acute glomerulonephritis due to inflammation of the glomeruli. Bacteriuria and changes in specific gravity are not as directly associated with this condition.

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