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. The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which sign of this disorder documented?

• A. Watery diarrhea
• B. Ribbon-like stools
• C. Profuse projectile vomiting
• D. Bright red blood and mucus in the stools

Correct answer: D

Rationale: Intussusception is a condition where a part of the bowel slides into the next section, causing an obstruction. The classic presentation includes severe abdominal pain that is crampy, intermittent, and may cause the child to draw knees to the chest. While vomiting can occur, it is not typically projectile in nature. A key hallmark of intussusception is the passage of bright red blood and mucus in the stools, often described as currant jelly-like. Watery diarrhea and ribbon-like stools are not typical signs of intussusception and should not be expected in a child with this condition.

3. A patient with idiopathic pulmonary arterial hypertension (IPAH) is receiving nifedipine (Procardia). Which assessment would best indicate to the nurse that the patient's condition is improving?

• A. Blood pressure (BP) is less than 140/90 mm Hg.
• B. Patient reports decreased exertional dyspnea
• C. Heart rate is between 60 and 100 beats/minute
• D. Patient's chest x-ray indicates clear lung fields

Correct answer: B

Rationale: The correct answer is for the patient to report decreased exertional dyspnea. In idiopathic pulmonary arterial hypertension (IPAH), exertional dyspnea is a significant symptom indicating disease severity. Improvement in this symptom suggests that the medication, nifedipine, is effective in managing the condition. While nifedipine can affect blood pressure (choice A) and heart rate (choice C), these parameters are not specific indicators for monitoring IPAH improvement. Choice D, clear lung fields on the chest x-ray, does not directly correlate with the effectiveness of therapy for IPAH. Therefore, the most relevant assessment to monitor improvement in a patient with IPAH receiving nifedipine is a decrease in exertional dyspnea.

4. Diabetic patients are more prone to ____________ than other people without this chronic disorder.

• A. infection
• B. increased oxygen saturation
• C. low fibrinogen
• D. constipation

Correct answer: A

Rationale: Diabetic patients are more prone to infection than other people without this chronic disorder. Diabetes weakens the immune system and impairs the body's ability to fight off infections, making individuals with diabetes more susceptible to various types of infections. Increased oxygen saturation, low fibrinogen, and constipation are not directly related to diabetes or the increased infection risk associated with the condition. Increased oxygen saturation is actually a positive health indicator, low fibrinogen levels are not a common issue in diabetes, and constipation is not a primary concern when comparing diabetic patients to others without the condition.

5. Following a diagnosis of acute glomerulonephritis (AGN) in their 6-year-old child, the parent remarks, 'We just don't know how he caught the disease!' The nurse's response is based on an understanding that

• A. AGN is a streptococcal infection that involves the kidney tubules
• B. The disease is easily transmissible in schools and camps
• C. The illness is usually associated with chronic respiratory infections
• D. It is not 'caught' but is a response to a previous B-hemolytic strep infection

Correct answer: D

Rationale: Acute glomerulonephritis (AGN) is generally considered an immune-complex disease in response to a previous B-hemolytic streptococcal infection, typically occurring 4 to 6 weeks prior. It is not an infectious disease but a noninfectious renal condition. Therefore, the parent's belief that the child 'caught' the disease is inaccurate. Choice A is incorrect because AGN is not a direct streptococcal infection involving the kidney tubules but an immune response to a prior streptococcal infection. Choice B is incorrect as AGN is not easily transmissible in schools and camps. Choice C is incorrect as AGN is not usually associated with chronic respiratory infections but with a previous streptococcal infection.

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