Nursing Elites

1. An emergency department nurse is performing an assessment on a child with a suspected diagnosis of intussusception. Which assessment question for the parents will elicit the most specific data related to this disorder?

• A. Does the child have any food allergies?
• B. What do the bowel movements look like?
• C. Has the child eaten any food in the last 24 hours?
• D. Can you describe the type of pain that the child is experiencing?

Correct answer: D

Rationale: The correct answer is asking the parents to describe the type of pain the child is experiencing because a report of severe colicky abdominal pain in a healthy, thriving child between 3 and 17 months of age is the classic presentation of intussusception. Typical behavior includes screaming and drawing the knees up to the chest. This specific question helps in identifying the key symptom of intussusception. Choices A, B, and C are important aspects of a health history but are not specific to the diagnosis of intussusception. Food allergies, bowel movements, and recent food intake are relevant for a comprehensive assessment but do not directly relate to the specific symptoms of intussusception.

2. A patient with Meningitis is being treated with Vancomycin intravenously 3 times per day. The nurse notes that the urine output during the last 8 hours was 200mL. What is the nurse's priority action?

• A. Check the patient's last BUN levels
• B. Ask the patient to increase their fluid intake
• C. Ask the physician to order a diuretic
• D. Notify the physician of this finding

Correct answer: D

Rationale: Vancomycin is a nephrotoxic drug and can cause impaired renal perfusion, which would lead to decreased urine output. This is a serious adverse effect that should be promptly reported to the physician. Checking the patient's last BUN levels (Choice A) may provide additional information but does not address the urgency of the situation. Asking the patient to increase fluid intake (Choice B) may not be appropriate if the cause is related to Vancomycin toxicity. Ordering a diuretic (Choice C) without physician evaluation can exacerbate the issue, making notifying the physician (Choice D) the most critical action to take.

3. Your patient has been diagnosed with acute bronchitis. You should expect that all of the following will be ordered EXCEPT:

• A. Increased fluid intake
• B. Cough medications
• C. Antibiotics
• D. Use of a vaporizer

Correct answer: C

Rationale: In the management of acute bronchitis, antibiotics are not typically prescribed unless there is a confirmed bacterial infection. Acute bronchitis is usually caused by a virus, so antibiotics are not effective in treating it. The primary focus is on symptom management and supportive care. Increased fluid intake helps keep the airway moist and liquefy secretions, aiding in their removal. Cough medications can help relieve cough symptoms. The use of a vaporizer can help moisten the air, making breathing more comfortable for the patient. It is crucial to differentiate between viral and bacterial causes of respiratory infections to avoid unnecessary antibiotic use and prevent antibiotic resistance. Therefore, the correct answer is 'Antibiotics.' Increased fluid intake, cough medications, and the use of a vaporizer are commonly recommended for managing symptoms and improving comfort in patients with acute bronchitis.

4. When asked to describe in layman's terms an overview of the condition called osteomyelitis, what would be the nurse's best response?

• A. Osteomyelitis is a gradual breakdown and weakening of your bones. It's most often age-related.
• B. Osteomyelitis is caused by not having enough Vitamin D, which in turn causes your bones to be softer and demineralized.
• C. Osteomyelitis is an infection in the bone. It can be caused by bacteria reaching your bone from outside or inside your body.
• D. This is a question that should be directed to your healthcare provider.

Correct answer: C

Rationale: Osteomyelitis is an infection in the bone that can be caused by bacteria reaching the bone either from outside the body (such as through an open fracture) or inside the body (such as through the bloodstream). This response provides a concise and accurate explanation of osteomyelitis, making it the best choice. Choices A and B provide inaccurate information about the condition, attributing it to age-related bone breakdown and Vitamin D deficiency, which are not correct causes of osteomyelitis. Choice D deflects the question instead of providing the patient with a clear explanation, making it an inappropriate response.

5. Following a diagnosis of acute glomerulonephritis (AGN) in their 6-year-old child, the parent remarks, 'We just don't know how he caught the disease!' The nurse's response is based on an understanding that

• A. AGN is a streptococcal infection that involves the kidney tubules
• B. The disease is easily transmissible in schools and camps
• C. The illness is usually associated with chronic respiratory infections
• D. It is not 'caught' but is a response to a previous B-hemolytic strep infection

Correct answer: D

Rationale: Acute glomerulonephritis (AGN) is generally considered an immune-complex disease in response to a previous B-hemolytic streptococcal infection, typically occurring 4 to 6 weeks prior. It is not an infectious disease but a noninfectious renal condition. Therefore, the parent's belief that the child 'caught' the disease is inaccurate. Choice A is incorrect because AGN is not a direct streptococcal infection involving the kidney tubules but an immune response to a prior streptococcal infection. Choice B is incorrect as AGN is not easily transmissible in schools and camps. Choice C is incorrect as AGN is not usually associated with chronic respiratory infections but with a previous streptococcal infection.

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