Nursing Elites

1. For a 6-year-old child hospitalized with moderate edema and mild hypertension associated with acute glomerulonephritis (AGN), which one of the following nursing interventions would be appropriate?

• A. Institute seizure precautions
• B. Weigh the child twice per shift
• C. Encourage the child to eat protein-rich foods
• D. Relieve boredom through physical activity

Correct answer: A

Rationale: Institute seizure precautions. The severity of the acute phase of AGN is variable and unpredictable; therefore, a child with edema, hypertension, and gross hematuria may be subject to complications, and anticipatory preparation such as seizure precautions is needed. Weighing the child twice per shift may be necessary for monitoring fluid balance but is not specifically related to the complications of AGN. Encouraging the child to eat protein-rich foods is important for overall nutrition but does not directly address the potential complications of AGN. Relieving boredom through physical activity is beneficial for overall well-being but is not the priority in this situation where seizure precautions are essential.

2. The nurse admits a patient who has a diagnosis of an acute asthma attack. Which statement indicates that the patient may need teaching regarding medication use?

• A. I have not had any acute asthma attacks during the last year.
• B. I became short of breath an hour before coming to the hospital.
• C. I've been taking Tylenol 650 mg every 6 hours for chest-wall pain.
• D. I've been using my albuterol inhaler more frequently over the last 4 days.

Correct answer: D

Rationale: The correct answer is 'I've been using my albuterol inhaler more frequently over the last 4 days.' This statement indicates that the patient may need teaching regarding medication use because an increased need for a rapid-acting bronchodilator suggests an exacerbation of asthma. The patient should be educated on recognizing worsening symptoms and the appropriate actions to take. Choices A, B, and C do not directly relate to asthma exacerbation or the need for medication teaching, making them incorrect. Choice A reflects a lack of recent acute asthma attacks, while choice B describes shortness of breath unrelated to medication use. Choice C mentions Tylenol use for chest-wall pain, which is not indicative of asthma exacerbation or medication teaching needs.

3. The parents of a newborn with a cleft lip are concerned and ask the nurse when the lip will be repaired. With which statement should the nurse respond?

• A. Cleft lip cannot be repaired.
• B. Cleft-lip repair is usually performed by 6 months of age.
• C. Cleft-lip repair is usually performed during the first months of life.
• D. Cleft-lip repair is usually performed between 6 months and 2 years.

Correct answer: C

Rationale: Cleft-lip repair is typically performed during the first few months of life to address functional and cosmetic concerns at an early stage. Early repair can enhance bonding and facilitate feeding. While revisions may be necessary later on, addressing the cleft lip early is essential. Option A is incorrect as cleft lip repair is a common surgical procedure. Option B is incorrect as repair is typically done earlier than 6 months for better outcomes. Option D is incorrect as the usual timing for repair is within the first months of life, not between 6 months and 2 years.

4. A man is prescribed lithium to treat bipolar disorder. The nurse is most concerned about lithium toxicity when he notices which of these assessment findings?

• A. The patient states he had a manic episode a week ago
• B. The patient states he has been having diarrhea every day
• C. The patient presents as severely depressed
• D. The patient has a rash and pruritus on his arms and legs

Correct answer: B

Rationale: The correct answer is when the patient states he has been having diarrhea every day. Persistent diarrhea can lead to dehydration, which can increase the risk of lithium toxicity. The other options, such as a manic episode, severe depression, or rash and pruritus, are not directly associated with an increased risk of lithium toxicity.

5. Which response would best assist the chemically impaired client in dealing with issues of guilt?

• A. Addiction usually causes people to feel guilty. Don't worry, it is a typical response due to your drinking behavior.
• B. What have you done that you feel most guilty about and what steps can you begin to take to help you lessen this guilt?
• C. Don't focus on your guilty feelings. These feelings will only lead you to drinking and taking drugs.
• D. You've caused a great deal of pain to your family and close friends, so it will take time to undo all the things you've done.

Correct answer: B

Rationale: The correct response is, 'What have you done that you feel most guilty about and what steps can you begin to take to help you lessen this guilt?' This response encourages the client to reflect on their actions, identify sources of guilt, and develop a plan to address and reduce these feelings constructively. Choice A is incorrect as it dismisses the client's guilt as typical, potentially invalidating their emotions. Choice C is incorrect as it suggests avoiding guilty feelings by turning to substance use, which is counterproductive. Choice D is incorrect as it focuses on the negative consequences of the client's actions without offering a constructive way to address and alleviate guilt.

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