Nursing Elites

1. The school nurse is caring for a boy with hemophilia who fell on his arm during recess. What supportive measures should the nurse use until factor replacement therapy can be instituted?

• A. Apply warm, moist compresses
• B. Apply pressure for at least 1 minute
• C. Elevate the area above the level of the heart
• D. Begin passive range-of-motion unless the pain is severe

Correct answer: C

Rationale: The correct supportive measure for the school nurse to use for a boy with hemophilia who fell on his arm during recess is to elevate the area above the level of the heart. Elevating the affected area helps reduce bleeding and swelling in a child with hemophilia until factor replacement therapy can be provided. Applying warm, moist compresses (Choice A) may worsen bleeding by dilating blood vessels. Applying pressure for at least 1 minute (Choice B) is not recommended for hemophilia as it can lead to increased bleeding. Beginning passive range-of-motion (Choice D) should be avoided as it can exacerbate bleeding and further injury in a child with hemophilia.

2. A 34-year-old woman, who is 36 weeks pregnant, is having a seizure. After you protect her airway and ensure adequate ventilation, you should transport her

• A. on her left side
• B. in the prone position
• C. in the supine position
• D. in a semi-sitting position

Correct answer: A

Rationale: Transporting a pregnant woman who is having a seizure on her left side is crucial as it helps improve blood flow to the fetus and reduces the risk of further complications. Placing her in the prone position or supine position may compromise blood flow to the fetus and worsen the situation. A semi-sitting position is also not recommended as it may not provide optimal blood flow to the fetus or adequately protect the airway during a seizure.

3. A group of students is reviewing information about the various types of insulin used to treat type 1 diabetes. The students demonstrate understanding of the information when they identify which of these insulins as having the longest duration.

• A. Lispro
• B. Regular
• C. NPH
• D. Glargine

Correct answer: D

Rationale: The correct answer is Glargine (Lantus) as it has the longest duration of action among the insulins listed, lasting 12 to 24 hours. Lispro (Humalog) and Regular (short-acting) insulins have shorter durations of action, typically lasting 3 to 6 hours. NPH (Neutral Protamine Hagedorn) insulin has an intermediate duration of action, lasting around 12 to 18 hours. Therefore, choices A, B, and C are incorrect in the context of insulin duration.

4. The nurse is caring for an infant with suspected pyloric stenosis. Which clinical manifestation would indicate pyloric stenosis?

• A. abdominal rigidity and pain on palpation
• B. rounded abdomen and hypoactive bowel sounds
• C. visible peristalsis and weight loss
• D. distention of the lower abdomen and constipation

Correct answer: C

Rationale: Visible peristalsis and weight loss are classic clinical manifestations of pyloric stenosis. The obstruction at the pyloric sphincter causes visible peristalsis as the stomach tries to push food through the narrowed opening, leading to the appearance of waves across the abdomen. Weight loss occurs due to poor feeding and frequent vomiting associated with pyloric stenosis. Choices A, B, and D are incorrect. Abdominal rigidity and pain on palpation, rounded abdomen and hypoactive bowel sounds, as well as distention of the lower abdomen and constipation are not typically seen in pyloric stenosis.

5. An infant with hypertrophic pyloric stenosis (HPS) is admitted to the pediatric unit. What does the nurse expect when palpating the infant’s abdomen?

• A. A distended colon
• B. Marked tenderness around the umbilicus
• C. An olive-sized mass in the right upper quadrant
• D. Rhythmic peristaltic waves in the lower abdomen

Correct answer: C

Rationale: When palpating the abdomen of an infant with hypertrophic pyloric stenosis (HPS), the nurse would expect to feel an olive-sized mass in the right upper quadrant. This finding is characteristic of HPS due to the hypertrophied pylorus muscle. Choices A, B, and D are incorrect. A distended colon is not typically associated with HPS. Marked tenderness around the umbilicus is not a specific finding of HPS. Rhythmic peristaltic waves in the lower abdomen are not expected in HPS, as the condition primarily affects the pylorus region of the stomach.

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