Nursing Elites

1. In a well-child clinic, the nurse examines many children daily. Which of the following toddlers requires further follow-up?

• A. A 13-month-old who is unable to walk
• B. A 20-month-old who is only using 2 and 3 word sentences
• C. A 24-month-old who cries during examination
• D. A 30-month-old who is only drinking from a sip cup

Correct answer: D

Rationale: The correct answer is D because a 30-month-old should have developed the skill to drink from a regular cup by this age. Drinking from a sip cup at this stage may indicate a delay in development. Choices A, B, and C are not as concerning as they can be within the range of normal development. A 13-month-old not walking yet, a 20-month-old using 2 and 3 word sentences, and a 24-month-old crying during examination are all behaviors that can fall within the spectrum of typical development for their respective ages.

2. When assessing a newborn infant with low set ears, short palpebral fissures, flat nasal bridge, and an indistinct philtrum, a priority maternal assessment by the nurse should be to ask about

• A. Alcohol use during pregnancy
• B. Usual nutritional intake
• C. Family genetic disorders
• D. Maternal and paternal ages

Correct answer: A

Rationale: The correct answer is A: Alcohol use during pregnancy. The physical features mentioned are indicative of fetal alcohol syndrome, a condition caused by maternal alcohol consumption during pregnancy. It is crucial for the nurse to inquire about alcohol use as it can help in diagnosing and managing the infant's condition. Choices B, C, and D are incorrect as they are not directly associated with the physical findings described in the newborn, which specifically point towards a potential history of alcohol exposure during pregnancy.

3. The nurse manager has a nurse employee who is suspected of having a problem with chemical dependency. Which intervention would be the best approach by the nurse manager?

• A. Confront the nurse about the suspicions in a private meeting
• B. Schedule a staff conference, without the nurse present
• C. Consult the human resources department about the issue and needed actions
• D. Counsel the employee to resign to avoid investigation

Correct answer: C

Rationale: Consulting with human resources is the best approach in this situation. It ensures that the issue is handled according to the organization's policies and that the nurse receives the appropriate support and intervention needed for chemical dependency. Confronting the nurse directly may lead to defensiveness and hinder a constructive resolution. Scheduling a staff conference without the nurse present can create unnecessary speculation and violate the employee's privacy. Counseling the employee to resign is not appropriate and does not address the underlying problem of chemical dependency.

4. A client with a history of hypertension is receiving enalapril (Vasotec). The nurse should monitor the client for which of the following side effects?

• A. Hyperkalemia
• B. Hypoglycemia
• C. Hypercalcemia
• D. Hypokalemia

Correct answer: A

Rationale: The correct answer is A: Hyperkalemia. Enalapril, an ACE inhibitor, can lead to hyperkalemia as a side effect. ACE inhibitors can cause potassium retention by inhibiting aldosterone secretion, which may result in elevated potassium levels. Hypoglycemia (choice B) is not typically associated with enalapril use. Hypercalcemia (choice C) is also not a common side effect of enalapril. Hypokalemia (choice D) is the opposite of what is expected with enalapril, as it tends to cause potassium retention.

5. A nurse is planning a nutrition class for a group of senior citizens at a community center and wants to emphasize the amount and types of fat in some foods versus others. What is the best teaching method for the nurse to use?

• A. Display posters with foods and inform seniors about fat content.
• B. Determine the foods most often eaten by this group and discuss the nutritional panel of each product.
• C. Show a movie about cooking with foods that are low in fat but delicious.
• D. Ask each senior to bring a food for others to taste, then estimate the fat content in these foods.

Correct answer: B

Rationale: The best teaching method for the nurse in this scenario is to determine the foods most often eaten by the group and discuss the nutritional panel of each product. This approach directly educates the seniors about the fat content in the foods they commonly consume, making the information more relevant and applicable to their daily lives. Choice A, displaying posters with foods, may not engage the seniors effectively or provide detailed information about fat content. Choice C, showing a movie about cooking with low-fat foods, may not address the specific fat content of the seniors' usual food choices. Choice D, asking seniors to bring foods for tasting and estimating fat content, could be subjective and less educational compared to discussing concrete nutritional information from food labels.

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