Nursing Elites

1. What is the most appropriate suggestion regarding the diet for an 18-month-old child experiencing mild diarrhea and 'mushy' stools, but tolerating fluids and solid foods?

• A. Applesauce, bananas, wheat toast
• B. Mashed potatoes with baked chicken
• C. Gelatin, strained cabbage, and custard
• D. Fluids only until the 'mushy' stools stop

Correct answer: B

Rationale: For a child with mild diarrhea who is tolerating fluids and solid foods, the most appropriate diet suggestion would be to continue feeding a normal diet to prevent dehydration, reduce stool frequency and volume, and hasten recovery. Foods that are well tolerated during diarrhea include bland but nutritional options like complex carbohydrates (rice, wheat, potatoes, cereals), yogurt with live cultures, cooked vegetables, and lean meats. Mashed potatoes with baked chicken provide a balance of nutrients and are easy on the digestive system. Options A and C contain foods that may worsen diarrhea; applesauce and gelatin can be high in sugars which can exacerbate diarrhea, and cabbage may be hard to digest for some individuals. Option D of offering fluids only can affect the child's nutritional status by not providing enough essential nutrients during the recovery period.

2. A patient with acute shortness of breath is admitted to the hospital. Which action should the nurse take during the initial assessment of the patient?

• A. Ask the patient to lie down to complete a full physical assessment.
• B. Briefly ask specific questions about this episode of respiratory distress.
• C. Complete the admission database to check for allergies before treatment.
• D. Delay the physical assessment to first complete pulmonary function tests.

Correct answer: B

Rationale: When a patient presents with acute shortness of breath, the initial assessment should focus on gathering specific information relevant to the current episode of respiratory distress. A comprehensive health history or full physical examination can be deferred until the acute distress has been addressed. Asking specific questions helps determine the cause of the distress and guides appropriate treatment. While checking for allergies is important, completing the entire admission database is not a priority during the initial assessment. Likewise, delaying the physical assessment for pulmonary function tests is not recommended as the immediate focus should be on addressing the acute respiratory distress before ordering further diagnostic tests or interventions.

3. While auscultating a patient's lungs, the nurse hears low-pitched, bubbling sounds during inhalation in the lower third of both lungs. How should the nurse document this finding?

• A. Inspiratory crackles at the bases
• B. Expiratory wheezes in both lungs
• C. Abnormal lung sounds in the apices of both lungs
• D. Pleural friction rub in the right and left lower lobes

Correct answer: A

Rationale: The correct answer is 'Inspiratory crackles at the bases.' Crackles are low-pitched, bubbling sounds typically heard during inspiration, which aligns with the nurse's finding. Expiratory wheezes are high-pitched sounds and are not consistent with the described auscultation findings. The lower third of both lungs refers to the bases, not the apices, so option C is incorrect. Pleural friction rubs are grating sounds heard during both inspiration and expiration, unlike the described finding of only hearing the sounds during inhalation in the lower third of both lungs.

4. You have accompanied the physician into the family waiting room to tell a young husband that his wife has not survived the car accident she was in. The husband is crying and distraught. What is the most appropriate approach to supporting this family member?

• A. Ask if he would like to donate his wife's organs
• B. Sit quietly with him
• C. Ask about funeral arrangements
• D. Consult social services

Correct answer: B

Rationale: The most caring and supportive approach in a time of extreme distress is usually to sit quietly with the distressed individual until they have had the opportunity to absorb the news and gather themselves. Providing a supportive presence is often the most valuable tool a caregiver can use when circumstances bring overwhelming emotional pain to those they are caring for. Asking about organ donation at this moment may come off as insensitive and should not be a priority. Inquiring about funeral arrangements and consulting social services can be addressed later, once the husband has had time to process the initial shock and emotions.

5. When teaching the client with tuberculosis about follow-up home care, the nurse should emphasize that a laboratory appointment for which of the following lab tests is critical?

• A. Liver function
• B. Kidney function
• C. Blood sugar
• D. Cardiac enzymes

Correct answer: A

Rationale: The nurse should emphasize the importance of monitoring liver function tests in clients taking INH due to the risk of hepatocellular injury and hepatitis associated with this medication. Regular assessment of liver enzymes can help detect liver damage early. Monitoring kidney function, blood sugar levels, or cardiac enzymes is not specifically required for clients taking INH and tuberculosis treatment.

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