Nursing Elites

1. The parents of an infant who underwent surgical repair of bladder exstrophy ask if the infant will be able to control their bladder as they get older. How should the nurse respond?

• A. Your child will need catheterization until bladder control is gained.
• B. Your child will be able to control their bladder like other children.
• C. You should potty train your child at the same time you normally would.
• D. Your child will not have a sphincter mechanism for the first 3 to 5 years, so urine will drain freely.

Correct answer: D

Rationale: Bladder exstrophy is a congenital defect where the infant is born with the bladder located on the outside of the body. Surgical repair typically occurs within the first 1 to 2 days of life. In the following 3 to 5 years post-surgery, urine will drain freely from the urethra due to the absence of a sphincter mechanism. This period allows the bladder to develop capacity as the child grows. Subsequent surgical interventions will be required to establish a functioning sphincter mechanism. Therefore, the correct response is that the child will not have a sphincter mechanism for the first 3 to 5 years, leading to urine draining freely. Options A, B, and C are incorrect as they do not align with the physiological process and management of bladder exstrophy.

2. The healthcare provider is reviewing the lab results of a patient who has presented in the Emergency Room. The lab results show that the troponin T value is at 5.3 ng/mL. Which of these interventions, if not already completed, would take priority over the others?

• A. Place the patient in a 90-degree position
• B. Assess whether the patient is taking diuretics
• C. Obtain and attach defibrillator leads
• D. Assess the patient's last ejection fraction

Correct answer: C

Rationale: In this scenario, the elevated Troponin T level indicates cardiac damage, possibly due to a myocardial infarction. A Troponin T value of 5.3 ng/mL is significantly elevated (normal levels are below 0.2 ng/mL), suggesting acute cardiac injury. Given the setting of an Emergency Room and the critical nature of the situation, the priority intervention should be to obtain and attach defibrillator leads. Elevated Troponin T levels can indicate a higher risk of arrhythmias, including ventricular fibrillation, which can lead to sudden cardiac arrest. Defibrillator leads are essential for monitoring the patient's cardiac rhythm and readiness for immediate defibrillation if necessary. Placing the patient in a 90-degree position (Choice A) or assessing diuretic use (Choice B) are not immediate priorities in this critical situation. Additionally, assessing the patient's last ejection fraction (Choice D) is important but not as urgent as preparing for potential life-threatening arrhythmias requiring defibrillation.

3. A patient is admitted to the hospital with a diagnosis of primary hyperparathyroidism. A nurse checking the patient's lab results would expect which of the following changes in laboratory findings?

• A. Elevated serum calcium
• B. Low serum parathyroid hormone (PTH)
• C. Elevated serum vitamin D
• D. Low urine calcium

Correct answer: A

Rationale: In primary hyperparathyroidism, there is excess secretion of parathyroid hormone (PTH) leading to increased resorption of calcium from bones and decreased excretion of calcium by the kidneys. This results in elevated serum calcium levels. Elevated serum calcium is a hallmark characteristic of primary hyperparathyroidism, making it the correct answer. Low serum parathyroid hormone (PTH) (Choice B) is incorrect because primary hyperparathyroidism is associated with elevated PTH levels due to the malfunction of the parathyroid glands. Elevated serum vitamin D (Choice C) is incorrect because primary hyperparathyroidism is not typically associated with elevated vitamin D levels. Low urine calcium (Choice D) is incorrect as primary hyperparathyroidism leads to decreased calcium excretion by the kidneys, resulting in high levels of calcium in the urine.

4. A patient who has just been admitted with community-acquired pneumococcal pneumonia has a temperature of 101.6�F with a frequent cough and is complaining of severe pleuritic chest pain. Which prescribed medication should the nurse give first?

• A. Codeine
• B. Guaifenesin (Robitussin)
• C. Acetaminophen (Tylenol)
• D. Piperacillin/tazobactam (Zosyn)

Correct answer: D

Rationale: The correct answer is Piperacillin/tazobactam (Zosyn). Early initiation of antibiotic therapy is crucial in cases of community-acquired pneumococcal pneumonia to reduce mortality. While providing symptomatic relief with medications like Codeine for cough, Guaifenesin for mucus clearance, and Acetaminophen for fever and pain is important, the priority should be to start antibiotic therapy to target the underlying infection. Piperacillin/tazobactam is an appropriate choice for treating severe community-acquired pneumonia caused by pneumococcal organisms.

5. During a physical exam, a healthcare professional assisting a client suspected of having meningitis bends the client's leg at the hip to a 90-degree angle. When attempting to extend the leg at the knee, the client experiences severe pain. What type of test is being performed?

• A. Brudzinski's sign
• B. Romberg's sign
• C. Kernig's sign
• D. Babinski's sign

Correct answer: C

Rationale: The healthcare professional is performing Kernig's sign, a test for meningeal irritation often seen in meningitis cases. Kernig's sign involves bending the client's leg at a 90-degree angle at the hip and then attempting to extend the leg at the knee. Severe pain during this maneuver indicates a positive Kernig's sign, suggesting irritation of the meningeal membranes. Brudzinski's sign involves flexing the neck causing involuntary flexion of the hips and knees; Romberg's sign assesses balance and proprioception; Babinski's sign checks for abnormal reflexes in the foot.

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