Nursing Elites

1. You are treating a 5-year-old child who has had severe diarrhea and vomiting for 3 days and is now showing signs of shock. Supplemental oxygen has been given, and you have elevated his lower extremities. En route to the hospital, you note that his work of breathing has increased. You should:

• A. begin positive-pressure ventilations and reassess the child.
• B. lower the extremities and reassess the child.
• C. listen to the lungs with a stethoscope for abnormal breath sounds.
• D. insert a nasopharyngeal airway and increase the oxygen flow.

Correct answer: B

Rationale: When the work of breathing increases after elevating the legs, it is important to lower the extremities. Elevating the lower extremities in a child with signs of shock can worsen the condition by reducing venous return to the heart. Lowering the extremities can help improve venous return and potentially alleviate the increased work of breathing.

2. When drawing blood from the diabetic patient for a glycosylated hemoglobin (HBA1c) test, the nurse explains to the woman that the test is used to determine:

• A. The highest glucose level in the past week.
• B. Her insulin levels.
• C. Glucose levels over the past three months.
• D. Her usual fasting glucose level.

Correct answer: C

Rationale: The glycosylated hemoglobin (HBA1c) test reflects the average blood sugar levels over the past three months. It provides a more comprehensive view of the individual's glucose control compared to a single point-in-time measurement like a fasting glucose level or the highest glucose level in the past week. Choice A is incorrect because it focuses on a single high glucose level rather than the overall control over a period. Choice B is incorrect as HBA1c is not a test for insulin levels. Choice D is incorrect as the HBA1c test does not reflect a single fasting glucose level but rather an average over a more extended period.

3. A clinic nurse reviews the record of a child just seen by a doctor and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder?

• A. Pallor
• B. Hyperactivity
• C. Exercise intolerance
• D. Gastrointestinal disturbances

Correct answer: C

Rationale: Aortic stenosis is a condition characterized by the narrowing of the aortic valve, leading to reduced blood flow from the heart to the body. This narrowing restricts the amount of oxygenated blood that can reach various tissues, including muscles. As a result, individuals with aortic stenosis may experience exercise intolerance, as their muscles may not receive an adequate oxygen supply during physical activity. This can manifest as fatigue, shortness of breath, and overall decreased exercise capacity. Pallor (choice A) is a pale appearance that may be seen in anemia or other conditions affecting blood flow but is not specific to aortic stenosis. Hyperactivity (choice B) and gastrointestinal disturbances (choice D) are not typically associated with aortic stenosis.

4. Which position is MOST appropriate for a mother in labor with a prolapsed umbilical cord?

• A. Supine with legs elevated
• B. Supine with hips elevated
• C. Left lateral recumbent
• D. Left side with legs elevated

Correct answer: B

Rationale: The most appropriate position for a mother in labor with a prolapsed umbilical cord is supine with hips elevated. This position helps reduce pressure on the cord, preventing further complications and ensuring optimal blood flow to the fetus.

5. What is a priority discharge instruction for a parent of a child experiencing the first episode of asthma?

• A. Asthma can be prevented by avoiding environmental and emotional triggers
• B. Asthma decreases the size of the airway causing distress
• C. Bronchodilators can cause tachycardia and restlessness
• D. If an attack occurs at home, the child should sit or stand

Correct answer: A

Rationale: Educating parents about avoiding triggers is a crucial part of managing asthma in children to prevent future asthma attacks. By identifying and minimizing exposure to triggers, parents can help reduce the risk of asthma exacerbations and improve the child's overall quality of life.

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