Nursing Elites

1. What are the most common signs and symptoms of leukemia related to bone marrow involvement?

• A. petechiae, infection, fatigue
• B. headache, papilledema, irritability
• C. muscle wasting, weight loss, fatigue
• D. decreased intracranial pressure, psychosis, confusion

Correct answer: A

Rationale: The correct answer is A: petechiae, infection, fatigue. In leukemia, bone marrow involvement leads to a decrease in normal blood cell production, resulting in petechiae (small red or purple spots on the skin), increased susceptibility to infections due to decreased white blood cells, and fatigue from anemia. Choices B, C, and D are incorrect because they do not directly relate to the typical signs and symptoms of leukemia with bone marrow involvement. Headache, papilledema, irritability, muscle wasting, weight loss, decreased intracranial pressure, psychosis, and confusion are not typically associated with leukemia and bone marrow involvement.

2. A child with a cardiac malformation associated with left-to-right shunting. What does this type of congenital disorder lead to primarily?

• A. Elevated hematocrit
• B. Severe growth retardation
• C. Clubbing of the fingers and toes
• D. Increased blood flow to the lungs

Correct answer: D

Rationale: Left-to-right shunting in a cardiac malformation results in increased blood flow to the lungs. This increased blood flow can lead to pulmonary hypertension and heart failure if left untreated. Elevated hematocrit (Choice A) is not a characteristic directly associated with left-to-right shunting. Severe growth retardation (Choice B) is not a typical manifestation of this type of congenital disorder. Clubbing of the fingers and toes (Choice C) is more commonly seen in conditions like chronic respiratory or cardiac diseases, not specifically with left-to-right shunting and associated cardiac malformations.

3. A 7-year-old child has an altered mental status, high fever, and a generalized rash. You perform your assessment and initiate oxygen therapy. En route to the hospital, you should be most alert for:

• A. vomiting
• B. seizures
• C. combativeness
• D. respiratory distress

Correct answer: B

Rationale: In a pediatric patient presenting with altered mental status, high fever, and a generalized rash, seizures are a significant concern. Febrile seizures can occur in children with high fevers and may lead to further complications. It is crucial to monitor for seizures and be prepared to manage them promptly. Vomiting, combativeness, and respiratory distress are also important considerations in pediatric patients; however, given the clinical presentation described, seizures take priority as they are a common complication in this scenario.

4. A nurse is caring for an infant with phenylketonuria (PKU). What diet should the nurse anticipate will be ordered by the healthcare provider?

• A. Fat-free
• B. Protein-enriched
• C. Phenylalanine-free
• D. Low-phenylalanine

Correct answer: D

Rationale: A low-phenylalanine diet is necessary for infants with PKU because it helps prevent the accumulation of phenylalanine, which can result in brain damage. Fat-free (Choice A) and protein-enriched (Choice B) diets are not specifically indicated for PKU. While phenylalanine-free (Choice C) may seem logical, complete elimination of phenylalanine is not practical or safe as it is an essential amino acid. Therefore, the correct choice is a low-phenylalanine diet, which restricts phenylalanine intake to a safe level.

5. What should the nurse recommend to reduce the risk of sudden infant death syndrome (SIDS) in a 6-month-old infant?

• A. Place the infant on their back to sleep
• B. Use a pacifier during sleep
• C. Have the infant sleep on their side
• D. Keep the infant's room cool

Correct answer: A

Rationale: Placing the infant on their back to sleep is the correct recommendation to reduce the risk of sudden infant death syndrome (SIDS). This sleep position has been shown to significantly decrease the incidence of SIDS. Using a pacifier during sleep (Choice B) can also help reduce the risk, but it is secondary to the back sleeping position. Having the infant sleep on their side (Choice C) is not recommended, as it increases the risk of SIDS. Keeping the infant's room cool (Choice D) may provide a comfortable sleeping environment but does not directly reduce the risk of SIDS.

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