Nursing Elites

1. One of the major differences in clinical presentation between Crohn disease (CD) and ulcerative colitis (UC) is that UC is more likely to cause which clinical manifestation?

• A. Pain
• B. Rectal bleeding
• C. Perianal lesions
• D. Growth retardation

Correct answer: B

Rationale: Rectal bleeding is more commonly associated with ulcerative colitis (UC) than with Crohn disease (CD). While both conditions can cause abdominal pain and growth issues, bleeding is a hallmark of UC due to its superficial mucosal inflammation. Perianal lesions are more characteristic of CD, and growth retardation is typically not a direct clinical manifestation of either CD or UC.

2. The nurses caring for a child are concerned about the child’s frequent requests for pain medication. During a team conference, a new nurse suggests they consider administering a placebo instead of the usual pain medication to see how the child responds. The team educates the nurse on why this is not appropriate and bases the decision on what knowledge?

• A. This practice is unjustified and unethical.
• B. This practice is effective in determining whether a child’s pain is real.
• C. The absence of a response to a placebo means the child’s pain has an organic basis.
• D. A positive response to a placebo will not occur if the child’s pain has an organic basis.

Correct answer: A

Rationale: The correct answer is A. The use of placebos without the patient’s consent is unethical and goes against the principles of beneficence and autonomy. Choice B is incorrect because using placebos does not provide reliable information about the presence or severity of the pain; it only indicates the response to the placebo itself. Choice C is wrong as the absence of a response to a placebo does not definitively mean that the child’s pain has an organic basis; there could be various reasons for the lack of response. Choice D is also incorrect as individuals may have a positive response to a placebo even if their pain has a significant organic cause. Therefore, the most appropriate response is A, emphasizing the ethical concerns surrounding the use of placebos without informed consent.

3. The parents of a 2-year-old boy who had a repair of exstrophy of the bladder at birth ask when they can begin toilet training their son. The nurse replies based on what knowledge?

• A. Most boys in the United States can be toilet trained at age 3 years.
• B. Training can begin when he has sufficient bladder capacity.
• C. Additional surgery may be necessary to achieve continence.
• D. They should begin now because he will require additional time.

Correct answer: B

Rationale: Toilet training should begin when the child has sufficient bladder capacity and control, which may be delayed in children who have undergone surgical repairs for conditions like bladder exstrophy. Premature training can lead to frustration and setbacks.

4. In the newborn, into what muscle is intramuscular vitamin K administered?

• A. Deltoid
• B. Dorsogluteal
• C. Rectus femoris
• D. Vastus lateralis

Correct answer: D

Rationale: In newborns, intramuscular vitamin K is traditionally administered into the vastus lateralis muscle. This site is preferred due to its large muscle mass and accessibility. The dorsogluteal site is not recommended for newborns due to the risk of injury to the sciatic nerve. The deltoid site is also not recommended for newborns. The rectus femoris muscle is not commonly used for intramuscular injections in newborns.

5. The nurse is preparing to complete documentation on a patient's chart. Which should be included in documentation of nursing care? (Select all that apply.)

• A. Reassessments
• B. Nursing care provided
• C. Initial assessments
• D. All of the above

Correct answer: D

Rationale: Proper documentation includes reassessments, initial assessments, care provided, and the patient's response, but incident reports are typically documented separately.

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