Nursing Elites

1. The healthcare provider is admitting a child with a Wilms tumor. Which is the initial assessment finding associated with this tumor?

• A. abdominal swelling
• B. weight gain
• C. hypotension
• D. increased urinary output

Correct answer: A

Rationale: Abdominal swelling is a classic presentation and often the first noticeable sign of a Wilms tumor. This occurs due to the tumor mass in the kidney, leading to abdominal distension. Weight gain (Choice B) is less likely as a presenting symptom compared to abdominal swelling. Hypotension (Choice C) is not typically associated with a Wilms tumor unless complications like bleeding or shock occur. Increased urinary output (Choice D) is not a typical finding for Wilms tumor; instead, patients may present with hematuria or urinary symptoms.

2. The nurse is reviewing the laboratory test results of a child with Addison's disease. What would the nurse expect to find?

• A. Hypernatremia
• B. Hyperkalemia
• C. Hyperglycemia
• D. Hypercalcemia

Correct answer: B

Rationale: In Addison's disease, adrenal insufficiency leads to decreased aldosterone production. This results in impaired sodium retention and potassium excretion, leading to hyperkalemia. Therefore, the correct answer is hyperkalemia (choice B). Hypernatremia (choice A) is less likely because of the loss of sodium in Addison's disease. Hyperglycemia (choice C) and hypercalcemia (choice D) are not typically associated with Addison's disease and are less likely to be present in this condition.

3. A nurse is planning an initial home care visit to a mother who gave birth to a high-risk infant. For what time of day should the nurse schedule the visit to be most productive?

• A. When the husband is out of the home.
• B. At a time when the mother is feeding the infant.
• C. At a time that is convenient for the family.
• D. When the nurse can spend time with the family.

Correct answer: C

Rationale: Scheduling the visit at a time that is convenient for the family is crucial for ensuring the family's receptiveness and availability, making the visit more productive. Choosing a time when the mother is feeding the infant (choice B) may not necessarily align with the family's overall convenience and may disrupt the feeding routine. Similarly, scheduling the visit when the husband is out of the home (choice A) might not be optimal as it may exclude an important family member and potentially impact the support system. While spending time with the family (choice D) is important, the primary focus should be on accommodating the family's schedule to maximize the effectiveness of the visit.

4. The nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management?

• A. Administer a nonsteroidal anti-inflammatory drug (NSAID) as ordered.
• B. Use guided imagery and therapeutic touch.
• C. Administer meperidine as ordered.
• D. Initiate pain assessment with a standardized pain scale.

Correct answer: D

Rationale: Initiating pain assessment with a standardized pain scale is crucial in effectively managing pain during a sickle cell crisis. This initial step helps the nurse understand the severity of the pain, which guides subsequent interventions. Administering medications, such as NSAIDs or meperidine, should only be done after a thorough pain assessment to ensure appropriate and individualized treatment. Using guided imagery and therapeutic touch may be beneficial as adjunct interventions, but they should not replace the essential first step of assessing the pain level accurately.

5. A 4-year-old fell from a third-story window and landed on her head. She is semiconscious with slow, irregular breathing and bleeding from her mouth. After performing a jaw-thrust maneuver with simultaneous stabilization of her head, what should you do next?

• A. Suction the oropharynx
• B. Insert a nasopharyngeal airway
• C. Initiate positive pressure ventilations
• D. Administer oxygen via mask

Correct answer: A

Rationale: In this scenario, the patient is experiencing airway compromise due to the fall and potential oropharyngeal obstruction from bleeding. Performing a jaw-thrust maneuver with head stabilization helps maintain the airway patency. The next step should be to suction the oropharynx to clear any blood or secretions, which can obstruct the airway and lead to aspiration. Inserting a nasopharyngeal airway may worsen bleeding or cause further injury to the patient's airway. Initiating positive pressure ventilations can be ineffective if the airway is not cleared first. Administering oxygen via mask is not the immediate priority; ensuring a patent airway by suctioning takes precedence.

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