Nursing Elites

1. Which of the following statements made by a client during an individual therapy session would the nurse most identify as reflecting schizoaffective disorder?

• A. ''I just want to stab myself with this pen.''
• B. ''What's the point in life anyways?''
• C. ''My thoughts are racing because of the conspiracies against me.''
• D. ''I hear voices every day and sometimes see old friends that don't exist.''

Correct answer: C

Rationale: The correct answer is, ''My thoughts are racing because of the conspiracies against me.'' Schizoaffective disorder combines the symptoms of bipolar disorder (mania and depression) with those of schizophrenia (delusions and disturbed thought processes). Racing thoughts are a characteristic symptom of a manic episode, while beliefs in conspiracies indicate paranoia, which are common in schizoaffective disorder. Choices A, B, and D do not specifically align with the symptoms of schizoaffective disorder. Choice A suggests self-harm, which may be seen in various mental health conditions; choice B reflects existential questioning or depression; and choice D describes hallucinations, which are more characteristic of schizophrenia rather than schizoaffective disorder.

2. When assessing a child admitted to the hospital with pyloric stenosis, which symptom would the nurse likely find when asking the parent about the child's symptoms?

• A. Watery diarrhea
• B. Projectile vomiting
• C. Increased urine output
• D. Vomiting large amounts of bile

Correct answer: B

Rationale: In pyloric stenosis, hypertrophy of the circular muscles of the pylorus causes narrowing of the pyloric canal between the stomach and the duodenum. The hallmark symptom of pyloric stenosis is projectile vomiting, which is the forceful expulsion of stomach contents. Other common symptoms include irritability, hunger and crying, constipation, and signs of dehydration. Watery diarrhea (Choice A) is not a typical symptom of pyloric stenosis. Increased urine output (Choice C) is not directly associated with this condition. Vomiting large amounts of bile (Choice D) is not a characteristic symptom of pyloric stenosis; instead, the vomitus in pyloric stenosis is non-bilious.

3. The nurse has been assigned to care for a neonate just delivered who has gastroschisis. Which concern should the nurse address in the client's plan of care?

• A. Infection.
• B. Poor body image.
• C. Decreased urinary elimination.
• D. Cracking oral mucous membranes.

Correct answer: A

Rationale: In a neonate with gastroschisis, the bowel herniates through a defect in the abdominal wall without a covering membrane, which puts the neonate at high risk of infection. Immediate surgical repair is necessary due to the vulnerability of the exposed bowel to infection. Therefore, the most critical concern for the nurse to address in the plan of care of a neonate with gastroschisis is preventing infection. Poor body image is not a priority in neonatal care as neonates do not have body image concerns. Decreased urinary elimination is not typically a direct consequence of gastroschisis as it primarily affects the gastrointestinal system, not the genitourinary system. Cracking oral mucous membranes are not relevant to gastroschisis as it involves the lower gastrointestinal system, not the oral cavity.

4. A 3-year-old had a hip spica cast applied 2 hours ago. In order to facilitate drying, the nurse should

• A. Expose the cast to air and turn the child frequently
• B. Use a heat lamp to reduce the drying time
• C. Handle the cast with the abductor bar
• D. Turn the child as little as possible

Correct answer: A

Rationale: After applying a hip spica cast, it is important to facilitate drying by exposing the cast to air and turning the child frequently. This helps promote even drying and prevents complications such as skin breakdown. Using a heat lamp can cause burns and is not recommended. Handling the cast with the abductor bar does not aid in drying the cast. Turning the child as little as possible is incorrect as regular turning is crucial to prevent complications.

5. The parent of an infant diagnosed with gastroesophageal reflux disease is receiving feeding instructions from the nurse. Which instruction should the nurse give to the parent to assist in reducing the episodes of emesis?

• A. Provide smaller, more frequent feedings.
• B. Burp the infant frequently during feedings.
• C. Thin the feedings by adding water to the formula.
• D. Thicken the feedings by adding rice cereal to the formula.

Correct answer: D

Rationale: Gastroesophageal reflux disease involves the backward flow of gastric contents into the esophagus due to sphincter issues. To reduce episodes of emesis, it is recommended to thicken feedings by adding rice cereal to the formula. This helps to weigh down the contents in the stomach, making regurgitation less likely. Providing smaller, more frequent feedings and burping the infant frequently are beneficial strategies for gastroesophageal reflux. However, in this case, thickening the feedings is the most appropriate intervention. Thinning the feedings by adding water to the formula is not recommended as it can decrease the caloric density of the formula and may not help in reducing reflux.

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