Nursing Elites

1. The nurse is caring for a child who had a tonsillectomy. Which clinical manifestation should the nurse observe the child for in the postoperative period?

• A. Arrhythmias
• B. Increased swallowing
• C. Increased blood sugar
• D. Increased urinary output

Correct answer: B

Rationale: Correct Answer: B. Increased swallowing can indicate bleeding at the surgical site, which is a potential complication after tonsillectomy. Choice A, Arrhythmias, are not typically associated with tonsillectomy. Choice C, Increased blood sugar, is not a common clinical manifestation after a tonsillectomy. Choice D, Increased urinary output, is not a typical clinical manifestation to observe for in the postoperative period after a tonsillectomy.

2. What should the healthcare provider consider when providing support to a family whose infant has just been diagnosed with biliary atresia?

• A. The prognosis for full recovery is excellent.
• B. Death usually occurs by 6 months of age.
• C. Liver transplantation may be needed eventually.
• D. Children with surgical correction live normal lives.

Correct answer: C

Rationale: When supporting a family whose infant has been diagnosed with biliary atresia, it is important to consider that liver transplantation may be needed eventually. Biliary atresia is a serious condition where bile flow from the liver to the gallbladder is blocked or absent. While surgical interventions like the Kasai procedure can temporarily improve bile flow and delay the need for transplantation, the long-term survival often depends on liver transplantation as the child grows older. Choices A, B, and D are incorrect because the prognosis for full recovery is not excellent as biliary atresia is a chronic condition that often requires ongoing medical management, death usually does not occur by 6 months of age but the condition does require intervention, and not all children with surgical correction can live normal lives without the need for further interventions like transplantation.

3. What measure of fluid balance status is most useful in a child with acute glomerulonephritis?

• A. Proteinuria
• B. Daily weight
• C. Specific gravity
• D. Intake and output

Correct answer: B

Rationale: Daily weight is the most accurate measure of fluid balance in children with acute glomerulonephritis, as it reflects changes in body fluid status more reliably than other measures like proteinuria or specific gravity.

4. Which laboratory value at the time of diagnosis should the nurse anticipate would determine the worst prognosis for a child with leukemia?

• A. Slow response to chemotherapy
• B. Platelets of 150,000/mcL
• C. Leukocytes less than 10,000/mcL
• D. Leukocytes of 275,000/mcL

Correct answer: D

Rationale: A high white blood cell count (leukocytes of 275,000/mcL) at diagnosis is associated with a worse prognosis in leukemia because it indicates a more aggressive disease with a higher tumor burden. Slow response to chemotherapy (choice A) is a consequence of the aggressive disease and not a determining factor at diagnosis. Platelets of 150,000/mcL (choice B) and leukocytes less than 10,000/mcL (choice C) are within normal ranges and not indicative of a worse prognosis in leukemia.

5. Which pediatric condition is characterized by a "string sign" on an upper GI series?

• A. Intussusception
• B. Hypertrophic pyloric stenosis
• C. Hirschsprung disease
• D. Meckel diverticulum

Correct answer: B

Rationale: The correct answer is B: Hypertrophic pyloric stenosis. The "string sign" is associated with hypertrophic pyloric stenosis, a condition where the pyloric canal is narrowed, leading to gastric outlet obstruction. Intussusception (choice A) typically presents with colicky abdominal pain and currant jelly stools. Hirschsprung disease (choice C) is characterized by the absence of ganglion cells in the distal colon. Meckel diverticulum (choice D) is a congenital outpouching of the small intestine that can present with painless rectal bleeding.

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