Nursing Elites

1. When drawing blood from the diabetic patient for a glycosylated hemoglobin (HBA1c) test, the nurse explains to the woman that the test is used to determine:

• A. The highest glucose level in the past week.
• B. Her insulin levels.
• C. Glucose levels over the past three months.
• D. Her usual fasting glucose level.

Correct answer: C

Rationale: The glycosylated hemoglobin (HBA1c) test reflects the average blood sugar levels over the past three months. It provides a more comprehensive view of the individual's glucose control compared to a single point-in-time measurement like a fasting glucose level or the highest glucose level in the past week. Choice A is incorrect because it focuses on a single high glucose level rather than the overall control over a period. Choice B is incorrect as HBA1c is not a test for insulin levels. Choice D is incorrect as the HBA1c test does not reflect a single fasting glucose level but rather an average over a more extended period.

2. The mother of an 11-year-old girl confides to the nurse that her child has no interest in school activities, exercise, or even family outings. The most appropriate response by the nurse would be:

• A. I would recommend that she see a counselor at school.
• B. I would not worry; she will grow out of it.
• C. Many girls this age go through a time of malaise and disinterest.
• D. If she still feels the same way when you come back for the next well-child visit, I will recommend a therapist.

Correct answer: A

Rationale: When a child shows a lack of interest in various activities, including school, exercise, and family outings, it is essential to address the underlying reasons. Recommending that the child see a counselor at school is crucial to explore potential issues and provide appropriate support and guidance. This approach can help identify any emotional, social, or behavioral concerns the child may be experiencing and facilitate early intervention and support. Choice B is incorrect because dismissing the mother's concerns and assuming the child will grow out of it without addressing the issue is not appropriate. Choice C is incorrect because while some children may go through phases of disinterest, it is essential to investigate further rather than generalizing. Choice D is incorrect because waiting until the next visit without taking proactive steps to address the current lack of interest may delay necessary support and intervention.

3. What is the most likely cause of a sudden onset of respiratory distress in a 5-year-old child with no fever?

• A. Infection of the lower airways.
• B. A progressive upper airway infection.
• C. Inflammation of the upper airway.
• D. A foreign body airway obstruction.

Correct answer: D

Rationale: A sudden onset of respiratory distress in a child without fever is most likely due to a foreign body airway obstruction. This obstruction can rapidly lead to difficulty breathing, stridor, and other signs of respiratory distress without necessarily causing a fever. Prompt recognition and intervention are crucial in such cases to prevent further complications and ensure the child's airway remains clear.

4. Which of the following is NOT an appropriate treatment for an 18-year-old woman with severe vaginal bleeding?

• A. Covering the vagina with a trauma dressing.
• B. Administering high concentrations of oxygen.
• C. Placing sterile dressings into the vagina.
• D. Keeping her warm with blankets.

Correct answer: C

Rationale: Placing sterile dressings into the vagina is not an appropriate treatment for severe vaginal bleeding. The correct approach involves applying pressure to the external vaginal area to control bleeding, covering the vagina with a trauma dressing to help with compression, administering high concentrations of oxygen to support oxygenation, and keeping the patient warm with blankets to prevent hypothermia. Placing sterile dressings into the vagina can introduce foreign material, increase the risk of infection, and obstruct proper wound management, making it an incorrect treatment option in this scenario.

5. What is a priority discharge instruction for a parent of a child experiencing the first episode of asthma?

• A. Asthma can be prevented by avoiding environmental and emotional triggers
• B. Asthma decreases the size of the airway causing distress
• C. Bronchodilators can cause tachycardia and restlessness
• D. If an attack occurs at home, the child should sit or stand

Correct answer: A

Rationale: Educating parents about avoiding triggers is a crucial part of managing asthma in children to prevent future asthma attacks. By identifying and minimizing exposure to triggers, parents can help reduce the risk of asthma exacerbations and improve the child's overall quality of life.

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