Nursing Elites

1. When assessing a child with chronic renal failure, which clinical manifestations would the nurse expect to find?

• A. Uremic frost
• B. Hypotension
• C. Massive hematuria
• D. Severe metabolic acidosis

Correct answer: A

Rationale: When assessing a child with chronic renal failure, the nurse would expect to find uremic frost as a clinical manifestation. Uremic frost, a white powdery deposit of urea on the skin, occurs in severe cases of chronic renal failure due to the accumulation of urea and other waste products in the blood. Hypotension and massive hematuria are less common in chronic renal failure, while severe metabolic acidosis is typically mild to moderate and not a prominent clinical manifestation.

2. The nurse is caring for a child with the following order: Methylprednisolone (Solu-Medrol) 20 mg IV, every 6 hours. The nurse has Methylprednisolone 100 mg in 2 mL available. How many mL should the nurse administer with each dose?

• A. 0.4 mL
• B. 0.2 mL
• C. 0.5 mL
• D. 0.6 mL

Correct answer: A

Rationale: The correct dosage to administer 20 mg is 0.4 mL, calculated by dividing the dose (20 mg) by the concentration (100 mg in 2 mL). This calculation ensures the accurate administration of the prescribed medication. Choices B, C, and D are incorrect as they do not reflect the correct calculation based on the provided concentration of the medication.

3. Physiologically, the child compensates for fluid volume losses by which mechanism?

• A. Inhibition of aldosterone secretion
• B. Hemoconcentration to reduce cardiac workload
• C. Fluid shift from interstitial space to intravascular space
• D. Vasodilation of peripheral arterioles to increase perfusion

Correct answer: C

Rationale: In response to dehydration, the body compensates by shifting fluids from the interstitial spaces to the intravascular space to maintain blood pressure and perfusion to vital organs. Hemoconcentration and vasoconstriction are other compensatory mechanisms but are less immediate.

4. What clinical manifestation(s) should the nurse expect to see as shock progresses in a child and becomes decompensated shock?

• A. Thirst
• B. Irritability
• C. Apprehension
• D. Confusion and somnolence

Correct answer: D

Rationale: As shock progresses and decompensation occurs, confusion and somnolence are indicative of reduced cerebral perfusion. Early signs include thirst and irritability, while confusion and altered consciousness appear as the condition worsens.

5. The nurse is conducting discharge teaching to an adolescent with a methicillin-resistant Staphylococcus aureus (MRSA) infection. What should the nurse include in the instructions?

• A. Avoid sharing of towels and washcloths
• B. All are applicable
• C. Use bleach when laundering towels and washcloths
• D. Take a daily bath or shower with an antibacterial soap

Correct answer: B

Rationale: Avoiding sharing of towels and washcloths, using bleach when laundering, and taking daily baths with antibacterial soap are critical to prevent the spread of MRSA. Cold water is not effective for laundering in these cases.

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