Nursing Elites

1. What will the nurse caution the parents of a child who has had a nephrectomy that he will have to avoid?

• A. Contact sports
• B. Horseback riding
• C. Alcohol
• D. Diuretic medications

Correct answer: A

Rationale: Children who have only one kidney should avoid contact sports to prevent injury to that remaining organ.

2. 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.

3. In the morning, a healthcare professional receives change-of-shift report on four pediatric clients, each of whom has some form of fluid-volume excess. Which of the children should the healthcare professional see first?

• A. The child with tachypnea and pulmonary congestion
• B. The child with hepatomegaly and normal respiratory rate
• C. The child with dependent and sacral edema and regular pulse
• D. The child with periorbital edema and normal respiratory rate

Correct answer: A

Rationale: The child with tachypnea and pulmonary congestion should be seen first. Tachypnea indicates an increased respiratory rate, a sign of possible respiratory distress. Pulmonary congestion suggests fluid accumulation in the lungs, posing a serious risk to respiratory function. Immediate attention is crucial in this case. Choice B is incorrect as hepatomegaly alone does not indicate an acute issue requiring immediate attention. Choices C and D, while showing signs of fluid-volume excess, do not present the same level of respiratory compromise as tachypnea and pulmonary congestion, making them lower priority.

4. How does an occupational therapist use clinical guidelines to inform practice with children and youth?

• A. Modify guidelines to fit the specific environment
• B. Establish systems to monitor outcomes
• C. Select the most recent guidelines without considering the client
• D. Consider guidelines that fit one's clientele and environment

Correct answer: C

Rationale: When using clinical guidelines to inform practice with children and youth, it is crucial for occupational therapists to not solely rely on the most recent guidelines but to consider the individual needs and contexts of each client. Selecting guidelines based solely on recency without considering the specific client can lead to ineffective or inappropriate interventions.

5. The patient is receiving a heparin infusion for the treatment of pulmonary embolism. Which assessment finding is most likely related to an adverse effect of heparin?

• A. HR of 60 bpm
• B. BP of 160/88
• C. Discolored urine
• D. Inspiratory wheezing

Correct answer: C

Rationale: The primary and most serious adverse effect of heparin is bleeding. However, discolored urine can indicate bleeding into the urinary tract, which is a potential adverse effect of heparin therapy. While changes in heart rate (HR) and blood pressure (BP) can occur due to various reasons, discolored urine specifically points towards a potential adverse effect related to heparin therapy.

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