Nursing Elites

1. The caregiver is teaching a parent of a young child with a newly diagnosed seizure disorder. The child is prescribed valproic acid (Depakote) for control of seizures. Which parental statement indicates the need for further education?

• A. I will not use carbonated beverages to dilute his medication.
• B. I will give his medication with food to minimize gastrointestinal upset.
• C. I will not let him chew his tablet.
• D. I will bring him to the physician's office for regular blood work to check his blood levels.

Correct answer: B

Rationale: The correct answer is B. Valproic acid should be administered with food to reduce the risk of gastrointestinal upset. Giving it on an empty stomach may increase the likelihood of adverse effects. The other statements are correct: A - Carbonated beverages should not be used to dilute the medication, C - The tablet should not be chewed, and D - Regular blood work is necessary to monitor valproic acid levels and potential side effects.

2. Which medication is most likely to cause serious respiratory depression as a potential adverse reaction?

• A. Morphine
• B. Pentazocine
• C. Hydrocodone
• D. Nalmefene

Correct answer: A

Rationale: Morphine, as a strong opioid agonist, has the highest likelihood of causing serious respiratory depression due to its potent effects on the central nervous system. While Pentazocine and Hydrocodone can also cause respiratory depression, they are less likely to do so compared to morphine. Nalmefene, an opioid antagonist, is used to reverse respiratory depression caused by opioids rather than causing it.

3. Which urinary diversion procedure is the least damaging to the body image of the adolescent?

• A. Urostomy
• B. Ileal conduit
• C. Nephrostomy
• D. Suprapubic placement

Correct answer: B

Rationale: The correct answer is B: Ileal conduit. The ileal conduit diverts urine to the colon, and the urine is excreted with the feces. Unlike urostomy, nephrostomy, and suprapubic placement, the ileal conduit does not require an external appliance, which can be less damaging to an adolescent's body image.

4. The 6-year-old child scheduled for an orchiopexy shyly asks the nurse, 'What are they going to do to me 'down there'? What is the nurse's best response?

• A. They are going to fix you up 'down there'.
• B. They will move your testicle from your abdomen to your scrotum.
• C. What do you think your doctor is going to do?
• D. You shouldn't worry. Your doctor knows exactly what to do.

Correct answer: C

Rationale: The nurse should encourage the child to express his thoughts and feelings about the upcoming surgery. This approach helps the child feel heard and understood while providing an opportunity to address any misconceptions or fears. By asking the child what he thinks the doctor will do, the nurse engages the child in a conversation that can help alleviate anxiety and build trust. School-age children often have fears related to bodily harm, and open communication can help alleviate such concerns. Choices A and D do not encourage open communication or address the child's concerns directly. Choice B provides too much detail that may overwhelm the child and is not age-appropriate for a 6-year-old.

5. A child is being cared for following a head injury. Which of the following findings should indicate to the healthcare provider that the child is developing diabetes insipidus?

• A. Urine specific gravity of 1.045
• B. Sodium level of 155
• C. Blood glucose level of 45
• D. Urine output of 35 ml per hour

Correct answer: B

Rationale: In a child with a head injury, the development of diabetes insipidus can occur due to pituitary hypofunction, leading to a deficiency of antidiuretic hormone. An elevated sodium level (hypernatremia) is a key finding in diabetes insipidus due to the excessive loss of free water in the urine, resulting in increased sodium concentration in the blood.

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