Nursing Elites

1. The nurse is assigned to care for a child who is scheduled for an appendectomy. Select the prescriptions that the nurse anticipates will be prescribed. Select one that doesn't apply.

• A. Initiate an IV line.
• B. Maintain an NPO status.
• C. Administer a Fleet enema.
• D. Administer intravenous antibiotics.

Correct answer: C

Rationale: For a child scheduled for an appendectomy, the administration of a Fleet enema is not typically required. An IV line is often initiated for fluid and medication administration, maintaining NPO status is necessary to prevent aspiration during surgery, and administering intravenous antibiotics may be part of the preoperative regimen. Therefore, the correct choice that does not apply in this case is administering a Fleet enema.

2. Why is it important to genotype HCV before initiating drug therapy?

• A. Side effects of nucleotide analogs
• B. Measures for improving the appetite
• C. Ways to increase activity and exercise
• D. Administering alpha-interferon (Intron A)

Correct answer: B

Rationale: Genotyping of HCV plays a crucial role in managing treatment as it helps determine the most effective therapy for the specific viral strain. It allows healthcare providers to personalize treatment regimens and predict response rates. The statement about acute HCV infection converting to chronic state is accurate, highlighting the need for appropriate management. Immune globulin and vaccines are not available for HCV, and Ribavirin is commonly used for chronic HCV infection. Improving appetite is essential in liver health as adequate nutritional intake supports hepatocyte regeneration. Choices A, C, and D are incorrect as they do not address the specific importance of genotyping in HCV treatment or the significance of appetite improvement in liver function.

3. The nurse is writing out discharge instructions for the parents of a child diagnosed with celiac disease. The nurse should focus primarily on which aspect of care?

• A. Restricting activity
• B. Following a gluten-free diet
• C. Following a lactose-free diet
• D. Giving medication to manage the condition

Correct answer: B

Rationale: The primary nursing consideration in the care of a child with celiac disease is to instruct the child and parents about proper dietary management. The cornerstone of managing celiac disease is maintaining a strict gluten-free diet to prevent symptoms and long-term complications. While medications may be part of the treatment plan, dietary adjustments, particularly following a gluten-free diet, are crucial for managing the condition effectively. Restricting activity is not the primary focus of care for celiac disease. A lactose-free diet is not typically necessary unless the child also has lactose intolerance, which is distinct from celiac disease.

4. Septic, anaphylactic, and neurogenic shock are all categorized as:

• A. Hypovolemic shock
• B. Cardiogenic shock
• C. Distributive shock
• D. Obstructive shock

Correct answer: C

Rationale: Septic, anaphylactic, and neurogenic shock are all types of distributive shock. Distributive shock is characterized by a decrease in systemic vascular resistance, leading to poor tissue perfusion. Septic shock is caused by severe infection, anaphylactic shock is an extreme allergic reaction, and neurogenic shock results from damage to the nervous system. Hypovolemic shock (Choice A) is characterized by a decrease in intravascular volume, cardiogenic shock (Choice B) is due to heart failure, and obstructive shock (Choice D) results from obstruction of blood flow. Therefore, the correct categorization for septic, anaphylactic, and neurogenic shock is distributive shock.

5. A patient is admitted to the emergency department complaining of sudden onset shortness of breath and is diagnosed with a possible pulmonary embolus. How should the nurse prepare the patient for diagnostic testing to confirm the diagnosis?

• A. Start an IV so contrast media may be given
• B. Ensure that the patient has been NPO for at least 6 hours.
• C. Inform radiology that a radioactive glucose preparation is needed
• D. Instruct the patient to undress to the waist and remove any metal objects

Correct answer: A

Rationale: For diagnosing pulmonary emboli, spiral computed tomography (CT) scans are commonly used, and contrast media may be given intravenously (IV) during the scan to enhance visualization of blood vessels. Chest x-rays are not typically diagnostic for pulmonary embolism. When preparing for a chest x-ray, the patient needs to undress and remove any metal objects. Bronchoscopy is used for examining the bronchial tree, not for assessing vascular changes, and the patient should be NPO 6 to 12 hours before the procedure. Positron emission tomography (PET) scans are primarily used to detect malignancies, and a radioactive glucose preparation is utilized for this purpose.

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