Nursing Elites

1. In the management of heart failure, which diuretic is preferred due to its demonstrated significant mortality reduction in patients with heart failure?

• A. Furosemide (Lasix)
• B. Hydrochlorothiazide (HydroDIURIL)
• C. Spironolactone (Aldactone)
• D. Mannitol (Osmitrol)

Correct answer: C

Rationale: Spironolactone, a potassium-sparing diuretic, is the preferred choice in heart failure due to its cardio-protective effect, leading to reduced mortality in patients with heart failure. It is used to manage both hypertension and edema, making it a valuable option in heart failure treatment.

2. A parent tells the nurse that her child is scheduled for an x-ray of the bladder and urethra that is done while the child is urinating. What is this test known as?

• A. Cystometrogram
• B. Cystoscopy
• C. Voiding cystourethrogram
• D. Intravenous pyelogram

Correct answer: C

Rationale: The correct test for an x-ray examination of the bladder and urethra before and during micturition is a voiding cystourethrogram. This procedure allows visualization of the bladder and urethra while the patient is urinating to assess for any abnormalities in the anatomy or function of these structures.

3. A nurse in an emergency department is caring for a school-age child who is experiencing an anaphylactic reaction. Which of the following is the priority action by the nurse?

• A. Elevate the head of the child's bed
• B. Insert a large-bore IV catheter for the child
• C. Determine the allergen that caused the child's reaction
• D. Administer IM epinephrine to the child

Correct answer: D

Rationale: In the management of anaphylaxis, the priority action for the nurse is to administer IM epinephrine to the child. Epinephrine is the first-line treatment for anaphylaxis as it helps reverse the severe manifestations of the reaction by constricting blood vessels, relaxing airway muscles, and decreasing hives and swelling. Elevating the head of the child's bed may be beneficial for respiratory distress but is not the priority over administering epinephrine. Inserting a large-bore IV catheter may be necessary for fluid resuscitation but is not the initial priority. Identifying the allergen is important for prevention and future management but is not the immediate action needed in the acute phase of an anaphylactic reaction.

4. A healthcare provider is assessing a child with acute lymphocytic leukemia. Which of the following findings is the priority for the healthcare provider to report?

• A. Bruising
• B. Petechiae
• C. Elevated WBC count
• D. Elevated platelet count

Correct answer: B

Rationale: The priority finding to report for a child with acute lymphocytic leukemia is petechiae. Petechiae indicate a low platelet count, which increases the risk of bleeding. Therefore, the healthcare provider should promptly report petechiae to initiate appropriate interventions to prevent bleeding complications.

5. A patient taking isotretinoin (Accutane) for acne vulgaris. Which statement indicates that the patient teaching has been effective?

• A. I should use a reliable form of birth control.
• B. I will stop taking the drug if my skin is dry.
• C. It is important to increase intake of vitamin A.
• D. I do not need to use sunblock while taking Accutane.

Correct answer: A

Rationale: The correct answer is A. Isotretinoin is highly teratogenic, which means it can cause birth defects. Therefore, it is crucial for patients, especially females of childbearing potential, to use effective forms of birth control to prevent pregnancy while taking this medication. This is a key component of patient teaching to ensure the safe use of isotretinoin. Choice B is incorrect because discontinuing isotretinoin abruptly can lead to a flare-up of acne. Choice C is incorrect because increasing vitamin A intake can be harmful due to the risk of hypervitaminosis A. Choice D is incorrect because isotretinoin makes the skin more sensitive to sunlight, so sunblock is essential to prevent sunburn and skin damage.

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