Nursing Elites

1. The emergency department charge nurse is reviewing the clients triaged in the last 30 minutes. The nurse is required to obtain a social service consult from which of the following clients?

• A. A 6-year-old who drank some diluted bleach.
• B. A 10-year-old who suffered burns in a house fire.
• C. A 12-year-old who fractured his arm in a fight at school.
• D. A 12-month-old without any oral intake for the last 12 hours.

Correct answer: A

Rationale: For children under 7 years, most states have laws that mandate reporting certain situations to social services or child protection, such as ingestions of toxic substances, fractures, suspected neglect, or abuse, and burns. In this scenario, the 6-year-old who drank diluted bleach falls under the category that requires a social service consult. The other choices involve injuries or conditions that may warrant medical attention but do not necessarily mandate a social service consult based on age-related legal requirements.

2. After a client with an Automated Internal Cardiac Defibrillator (AICD) is successfully defibrillated for Ventricular Fibrillation (VF), what should the nurse do next?

• A. Go to the client to assess for signs and symptoms of decreased cardiac output.
• B. Call the physician to inform them of the VF episode for medication adjustments.
• C. Call the 'on-call' person in the cath lab to re-charge the ICD in case of a recurrence.
• D. Document the incident on the code report form and follow up regularly.

Correct answer: A

Rationale: After a client is successfully defibrillated, the immediate priority is to assess the client for signs and symptoms of decreased cardiac output, such as altered level of consciousness, chest pain, shortness of breath, or hypotension. This assessment is crucial to determine the effectiveness of the defibrillation and the client's current hemodynamic status. Calling the physician for medication adjustments without assessing the client first could delay essential interventions. Contacting the 'on-call' person in the cath lab to re-charge the ICD is not the initial action needed after successful defibrillation. Documenting the incident is important but should not take precedence over assessing the client's immediate condition.

3. While assessing a patient in the ICU, a nurse observes signs of a weak pulse, quick respiration, acetone breath, and nausea. Which of the following conditions is most likely occurring?

• A. Hypoglycemic patient
• B. Hyperglycemic patient
• C. Cardiac arrest
• D. End-stage renal failure

Correct answer: B

Rationale: The correct answer is a hyperglycemic patient. The signs described - weak pulse, quick respiration, acetone breath, and nausea - are indicative of hyperglycemia. A hypoglycemic patient would typically present with different signs such as pale skin, sweating, and confusion. Cardiac arrest would manifest with sudden loss of heart function and consciousness, not the signs described. End-stage renal failure would present with symptoms related to kidney dysfunction like edema, fatigue, and changes in urine output, which are not mentioned in the scenario.

4. The nurse is caring for a client admitted with Class III/IV Pulmonary Hypertension. The nurse explains to the client that Lanoxin is being administered to the client in order to:

• A. Manage peripheral edema
• B. Improve right ventricular function
• C. Increase pulmonary pressure
• D. Constrict the pulmonary vessels

Correct answer: B

Rationale: The correct answer is to improve right ventricular function. Lanoxin, also known as digoxin, is a cardiac glycoside that works by slowing the heart rate and increasing myocardial contractility, especially in the ventricles. This action helps improve the efficiency of the heart's pumping function, particularly the right ventricle in conditions like pulmonary hypertension. Choice A, managing peripheral edema, is not directly related to Lanoxin's mechanism of action. Choice C, increasing pulmonary pressure, is incorrect as Lanoxin is not used to increase pressure in the pulmonary circulation. Choice D, constricting the pulmonary vessels, is incorrect as Lanoxin does not cause vasoconstriction in the pulmonary vessels but rather acts on the heart's contractility.

5. What is most important for the healthcare professional to do prior to initiating peritoneal dialysis?

• A. Aspirate to check placement
• B. Ensure the client voids
• C. Irrigate the catheter to maintain patency
• D. Warm the fluids

Correct answer: D

Rationale: The correct answer is to warm the fluids. Warming the dialysis fluids is crucial before initiating peritoneal dialysis to prevent abdominal discomfort and promote vasodilation, which helps in achieving good exchange in the peritoneum. Aspirating to check placement (Choice A) is not typically necessary before initiating peritoneal dialysis. Ensuring the client voids (Choice B) is not directly related to the procedure of peritoneal dialysis. Irrigating the catheter to maintain patency (Choice C) is usually done as part of routine care but is not specifically required prior to initiating peritoneal dialysis. Therefore, the most important action to take before starting peritoneal dialysis is to warm the fluids.

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