Nursing Elites

1. A teenage client is admitted to the hospital because of acetaminophen (Tylenol) overdose. Overdoses of acetaminophen can precipitate life-threatening abnormalities in which of the following organs?

• A. lungs
• B. liver
• C. kidneys
• D. adrenal glands

Correct answer: B

Rationale: Acetaminophen is extensively metabolized in the liver. An overdose of acetaminophen can lead to severe liver damage and even liver failure, which can be life-threatening. Choices A, C, and D are incorrect because although prolonged use of acetaminophen may lead to an increased risk of renal dysfunction, a single overdose does not typically cause life-threatening abnormalities in the lungs, kidneys, or adrenal glands.

2. A nurse, assigned to care for a hospitalized child who is 8 years old, assists with planning care, taking into account Erik Erikson's theory of psychosocial development. According to Erikson's theory, which task represents the primary developmental task of this child?

• A. Developing a sense of control over self and body functions
• B. Mastering useful skills and tools
• C. Gaining independence from parents
• D. Developing a sense of trust in the world

Correct answer: B

Rationale: According to Erikson's theory of psychosocial development, the primary task for an 8-year-old child aligns with the stage of industry versus inferiority. This stage focuses on mastering useful skills and tools of the culture, emphasizing competence in various areas. Option A, 'Developing a sense of control over self and body functions,' is more characteristic of the toddler stage, emphasizing autonomy and self-regulation. Option C, 'Gaining independence from parents,' is more relevant to the adolescent stage, where identity development and autonomy become crucial. Option D, 'Developing a sense of trust in the world,' pertains to the infant stage, highlighting the importance of forming secure attachments. Therefore, the correct answer is B as it directly corresponds to the developmental tasks associated with an 8-year-old child according to Erikson's theory.

3. In the context of diagnostic genetic counseling, which of the following choices is typically not made by clients?

• A. Terminating the pregnancy.
• B. Preparing for the birth of a child with special needs.
• C. Accessing support services before the birth.
• D. Completing the grieving process before the birth.

Correct answer: D

Rationale: In diagnostic genetic counseling, clients may face difficult decisions based on test results. Terminating the pregnancy is a choice some clients may consider if severe abnormalities are detected. Preparing for the birth of a child with special needs involves getting ready to care for a child who may require extra attention and support. Accessing support services before the birth can help clients connect with resources and professionals for assistance during and after the pregnancy. Completing the grieving process before birth is not typically a choice made in the context of genetic counseling. The grieving process often starts or continues after distressing results and can extend beyond the birth of the child. Therefore, the correct answer is completing the grieving process before the birth.

4. While assessing for costovertebral angle tenderness, a nurse percusses the area, and the client complains of sharp pain. The nurse interprets this finding as most indicative of which disorder?

• A. Liver enlargement
• B. Ovarian infection
• C. Spleen enlargement
• D. Kidney inflammation

Correct answer: D

Rationale: When assessing for costovertebral angle tenderness, sharp pain on percussion of the area indicates inflammation of the kidney or paranephric area. The correct technique involves placing one hand over the 12th rib, at the costovertebral angle, and thumping that hand with the ulnar edge of the other fist. The client normally feels a thud and should not experience pain. Ovarian infection, liver enlargement, or spleen enlargement are not associated with the costovertebral angle tenderness. Therefore, the correct answer is kidney inflammation.

5. When a nurse-midwife, performing a vaginal examination of a client who suspects that she is pregnant, documents the presence of the Chadwick sign, what does this indicate?

• A. That the cervix appears violet
• B. That cervical softening is present
• C. A positive sign of pregnancy
• D. A thinning of the cervix

Correct answer: A

Rationale: The correct interpretation of the Chadwick sign is that the cervix appears violet in color. This sign is a probable sign of pregnancy, characterized by the violet coloration of the cervix due to increased vascularity of the pelvic organs. It is not a definitive positive sign of pregnancy but rather a probable one. Choices B and D are incorrect as cervical softening is known as the Goodell sign, and thinning of the cervix is referred to as the Hegar sign. These signs are also probable signs of pregnancy, but they do not specifically indicate the Chadwick sign.

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