Nursing Elites

1. Parents of a school-age child ask the nurse for suggestions in helping the child who is demonstrating school avoidance. What is an appropriate suggestion by the nurse?

• A. Take the child to the healthcare provider for testing.
• B. Be firm and insist the child go to school.
• C. Allow the child to stay home and rest.
• D. Consult with the teacher at school.

Correct answer: B

Rationale: When a child is demonstrating school avoidance, it is important for parents to be firm and insist that the child go to school. This helps establish a routine and prevents the behavior from becoming a pattern. Taking the child to the healthcare provider for testing (Choice A) may not be necessary at this stage as school avoidance is a behavioral issue. Allowing the child to stay home and rest (Choice C) may reinforce the avoidance behavior. While consulting with the teacher at school (Choice D) is important, the immediate focus should be on addressing the avoidance behavior at home.

2. What pathophysiologic process is producing the symptoms of gout in a client with sudden onset of big toe joint pain and swelling?

• A. Deposition of crystals in the synovial space of the joints produces inflammation and irritation.
• B. Degeneration of joint cartilage causing inflammation.
• C. Infection of the joint space leading to inflammation.
• D. Increased synovial fluid causing joint swelling and pain.

Correct answer: A

Rationale: The correct answer is A. Gout is characterized by the deposition of uric acid crystals in the synovial fluid of joints, which triggers inflammation and pain. This process is known as crystal-induced arthritis. Choice B is incorrect as gout does not involve degeneration of joint cartilage. Choice C is incorrect as gout is not caused by an infection of the joint space. Choice D is incorrect as gout does not result from increased synovial fluid but rather from the deposition of uric acid crystals.

3. An older adult woman with a long history of COPD is admitted with progressive shortness of breath and a persistent cough, is anxious, and is complaining of dry mouth. Which intervention should the nurse implement?

• A. Administer a prescribed sedative
• B. Encourage client to drink water
• C. Apply a high flow venturi mask
• D. Assist her to an upright position

Correct answer: D

Rationale: Assisting the client to an upright position is the most appropriate intervention in this situation. Placing the client upright helps improve lung expansion by reducing diaphragmatic pressure, facilitating better air exchange, and increasing oxygenation. This position also aids in easing breathing efforts. Administering a sedative (Choice A) may further depress the respiratory system, worsening the breathing problem. Encouraging the client to drink water (Choice B) may not directly address the respiratory distress caused by COPD. Applying a high flow venturi mask (Choice C) may be beneficial in some cases but assisting the client to an upright position should be the priority to optimize respiratory function.

4. What could suddenly occur in a child with acute epiglottitis?

• A. Increased carbon dioxide levels
• B. Airway obstruction
• C. Inability to swallow
• D. Bronchial collapse

Correct answer: B

Rationale: In acute epiglottitis, the infected epiglottis becomes inflamed and can lead to sudden airway obstruction, which is a life-threatening emergency. This can cause difficulty breathing and necessitates immediate intervention to secure the airway. Increased carbon dioxide levels may occur due to inadequate ventilation resulting from airway obstruction, but the primary concern is the obstruction itself, not the carbon dioxide levels. Inability to swallow may be present due to pain and swelling in the throat but is not the immediate life-threatening complication associated with acute epiglottitis. Bronchial collapse is not a typical consequence of acute epiglottitis.

5. The nurse is triaging clients who have been injured during a tornado. Which client requires immediate action?

• A. A young male with a minor laceration on his forearm.
• B. An elderly woman with a dislocated shoulder who is calm.
• C. A middle-aged female with a broken humerus who is unable to follow commands and is crying.
• D. A teenager with abrasions and a bruised knee.

Correct answer: C

Rationale: The middle-aged female with a broken humerus who is unable to follow commands and is crying requires immediate action. These symptoms indicate a possible head injury or severe emotional distress that need urgent attention. Choice A is not as urgent since a minor laceration can be addressed after more critical cases. Choice B, although having a dislocated shoulder, is stable, as the client is calm. Choice D presents with minor injuries that can wait while more critical cases are addressed.

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