Nursing Elites

1. A child with nephrotic syndrome has not experienced diuresis after a month on corticosteroids. What protocol can the nurse encourage to induce diuresis?

• A. Ibuprofen, an anti-inflammatory agent
• B. Furosemide (Lasix), a diuretic
• C. Ciprofloxacin (Cipro), an antibiotic
• D. Cyclophosphamide (Cytoxan), an immunosuppressant

Correct answer: B

Rationale: To induce diuresis in a child with nephrotic syndrome who has not responded to corticosteroids, a diuretic like Furosemide (Lasix) is appropriate. Furosemide helps increase urine production and reduce fluid retention. Ibuprofen is an anti-inflammatory agent and does not directly induce diuresis. Ciprofloxacin is an antibiotic and is not used to promote diuresis. Cyclophosphamide is an immunosuppressant, not an antisuppressant, and is not typically used to induce diuresis in nephrotic syndrome.

2. A healthcare provider is assessing an infant who has hydrocephalus and is 6 hours postoperative following placement of a ventriculoperitoneal shunt. Which of the following findings should the provider report to the healthcare provider?

• A. Decreased urine output
• B. Temperature of 37.5 degrees C (99.5 degrees F)
• C. Heart rate 130/min
• D. Leakage of cerebrospinal fluid

Correct answer: D

Rationale: The provider should report the leakage of cerebrospinal fluid to the healthcare provider as it may indicate shunt malfunction or infection, requiring immediate attention to prevent complications. Decreased urine output, a temperature of 37.5 degrees C, and a heart rate of 130/min are common postoperative findings and may not be directly related to shunt function. While these findings should still be monitored, they do not require immediate reporting like cerebrospinal fluid leakage.

3. How would you best evaluate the clinical usefulness of a test?

• A. Decide on using a single test for all clients and families
• B. Consider what needs to be collected and discuss with colleagues
• C. Ask the family for a test suggestion
• D. Read the statistical methods used to validate the scores

Correct answer: B

Rationale: When evaluating the clinical usefulness of a test, the best approach is to consider what specific information needs to be collected based on the clients' needs. Discussing these considerations with colleagues helps in ensuring that the chosen test is appropriate and beneficial for the individuals being assessed. Choice A is incorrect as using a single test for all clients may not account for individual differences. Choice C is incorrect as the family's suggestion alone may not align with clinical needs. Choice D is incorrect as understanding statistical methods alone may not fully capture the clinical utility of a test.

4. What is the most appropriate nursing consideration for a patient who is prescribed verapamil and digoxin?

• A. Restrict intake of oral fluids and high-fiber foods
• B. Take an apical pulse for 30 seconds before administration
• C. Notify the healthcare provider of nausea, vomiting, and visual changes
• D. Hold the medications if the heart rate is greater than 110 bpm

Correct answer: C

Rationale: When a patient is prescribed verapamil and digoxin, it is crucial to monitor for signs of digoxin toxicity due to the potential interaction between these medications. Verapamil can elevate digoxin blood serum levels, increasing the risk of toxicity. Symptoms of digoxin toxicity include nausea, vomiting, and visual changes. Therefore, the most appropriate nursing consideration is to notify the healthcare provider of these symptoms. Restricting intake of oral fluids and high-fiber foods is not a specific consideration related to this medication combination. Before administering digoxin, it is essential to take an apical pulse for a full minute, not just 30 seconds, to ensure accuracy. Additionally, holding the medications if the heart rate exceeds 110 bpm is not a typical response to the combination of verapamil and digoxin, which can cause bradycardia rather than tachycardia.

5. What is the priority nursing action when preparing a neonate born with a gastroschisis defect for transport to a pediatric hospital for corrective surgery?

• A. Covering the exposed intestines with sterile moist gauze
• B. Wrapping the newborn warmly in two or three blankets
• C. Providing sterile water feeding to maintain hydration during transport
• D. Allowing the parents of the newborn to see their child prior to transport

Correct answer: A

Rationale: The priority nursing action when preparing a neonate born with a gastroschisis defect for transport is to cover the exposed intestines with sterile moist gauze. This action helps prevent infection and keeps the tissue viable during transportation to the pediatric hospital for corrective surgery.

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