Nursing Elites

1. Which food should the assistive personnel be instructed to remove from the child's food tray based on the prescribed treatment for nephrotic syndrome?

• A. Pickle
• B. Wheat toast
• C. Baked chicken
• D. Steamed vegetables

Correct answer: A

Rationale: In nephrotic syndrome, a no-added-salt diet is recommended to manage the condition. High-sodium foods like pickles should be avoided as they can exacerbate fluid retention and swelling. Wheat toast, baked chicken, and steamed vegetables are generally suitable for individuals with nephrotic syndrome as they are low in sodium and protein, which are important considerations for this condition. Therefore, the correct choice is to remove the pickles from the child's food tray.

2. A patient with acute dyspnea is scheduled for a spiral computed tomography (CT) scan. Which information obtained by the nurse is a priority to communicate to the health care provider before the CT?

• A. Allergy to shellfish
• B. Apical pulse of 104
• C. Respiratory rate of 30
• D. Oxygen saturation of 90%

Correct answer: A

Rationale: Because iodine-based contrast media is used during a spiral CT, the patient may need to have the CT scan without contrast or be premedicated before injection of the contrast media. The increased pulse, low oxygen saturation, and tachypnea all indicate a need for further assessment or intervention but do not indicate a need to modify the CT procedure.

3. A patient with a possible pulmonary embolism complains of chest pain and difficulty breathing. The nurse finds a heart rate of 142 beats/minute, blood pressure of 100/60 mmHg, and respirations of 42 breaths/minute. Which action should the nurse take first?

• A. Administer anticoagulant drug therapy.
• B. Notify the patient's healthcare provider.
• C. Prepare the patient for a spiral computed tomography (CT).
• D. Elevate the head of the bed to a semi-Fowler's position.

Correct answer: D

Rationale: The patient presents with symptoms indicative of a pulmonary embolism (PE), such as chest pain, difficulty breathing, tachycardia, hypotension, and tachypnea. Elevating the head of the bed to a semi-Fowler's position is the priority to improve ventilation and gas exchange. This intervention should be initiated promptly to optimize oxygenation. Subsequent actions, such as notifying the healthcare provider, preparing for a spiral CT scan, and administering anticoagulant therapy, can follow after the patient's position is adjusted. The spiral CT scan is typically used to confirm the diagnosis of PE, and anticoagulant therapy is initiated upon confirmation of the diagnosis by the healthcare provider. Therefore, the immediate focus is on improving the patient's respiratory status by elevating the head of the bed.

4. A nurse has just started her rounds delivering medication. A new patient on her rounds is a 4-year-old boy who is non-verbal. This child does not have any identification on. What should the nurse do?

• A. Contact the provider
• B. Ask the child to write their name on paper
• C. Ask a coworker about the identification of the child
• D. Ask the father who is in the room the child's name

Correct answer: D

Rationale: When encountering a non-verbal child without identification, it is appropriate for the nurse to ask the accompanying parent or guardian for the child's name. The father, being present in the room, can provide the necessary information. This ensures accurate identification to deliver the correct medication. Contacting the provider may cause unnecessary delays. Asking a non-verbal child to write their name is not feasible. Asking a coworker may not provide reliable identification as they may not have direct knowledge.

5. A patient's chart indicates a history of meningitis. Which of the following would you NOT expect to see with this patient if this condition were acute?

• A. Increased appetite
• B. Vomiting
• C. Fever
• D. Poor tolerance of light

Correct answer: A

Rationale: The correct answer is 'Increased appetite.' In cases of acute meningitis, loss of appetite would be expected rather than an increase. Meningitis is often caused by an infectious agent that colonizes or infects various sites in the body, leading to systemic symptoms. Common symptoms of acute meningitis include fever, vomiting, and poor tolerance of light due to meningeal irritation. The inflammatory response in the meninges can result in symptoms like photophobia. Increased appetite is not typically associated with acute meningitis. Therefore, choice A is the least likely symptom to be observed in a patient with acute meningitis. Choices B, C, and D are symptoms commonly seen in acute meningitis due to the inflammatory process affecting the central nervous system and meninges.

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