Nursing Elites

1. A child is suspected of suffering from intussusception. The nurse should be alert to which clinical manifestation of this condition?

• A. Tender, distended abdomen
• B. Presence of fecal incontinence
• C. Incomplete development of the anus
• D. Infrequent and difficult passage of dry stools

Correct answer: A

Rationale: Intussusception is an invagination of a section of the intestine into the distal bowel, and it is the most common cause of bowel obstruction in children aged 3 months to 6 years. A tender, distended abdomen is a typical clinical manifestation of intussusception. The presence of fecal incontinence is not a characteristic presentation of intussusception; it describes encopresis, which generally affects preschool and school-aged children but is not specific to intussusception. Incomplete development of the anus describes imperforate anus, a disorder diagnosed in the neonatal period, not intussusception. The infrequent and difficult passage of dry stools is characteristic of constipation, a common issue in children that can occur at any age, although it often peaks at 2 to 3 years old.

2. A nurse prepares to care for a 4-year-old newly admitted for rhabdomyosarcoma. The nurse should alert the staff to pay more attention to the function of which area of the body?

• A. All striated muscles
• B. The cerebellum
• C. The kidneys
• D. The leg bones

Correct answer: A

Rationale: Rhabdomyosarcoma is the most common soft tissue sarcoma in children, originating in striated (skeletal) muscles and potentially affecting any part of the body. Symptoms vary based on the location of the tumor. In the head or neck area, symptoms may include sudden bulging or swelling of the eyes, conjunctival chemosis, and headache. Rhabdomyosarcoma can also impact organs like the urinary or reproductive system. Common metastatic sites include the lungs. Therefore, the nurse should pay attention to the function of all striated muscles in the child to monitor for any signs or symptoms related to the disease. Choices B, C, and D are incorrect as rhabdomyosarcoma primarily involves striated muscles and does not specifically target the cerebellum, kidneys, or leg bones.

3. When caring for an asthmatic patient with an early-phase reaction, which of the following is indicative of an early-phase reaction?

• A. Rapid bronchospasms
• B. Inflammatory epithelial lesions
• C. Increased secretions
• D. Increased mucosal edema

Correct answer: A

Rationale: Rapid bronchospasms are a symptom of an early-phase reaction in an asthmatic patient. During the early phase, bronchospasms occur due to immediate hypersensitivity reactions. Inflammatory epithelial lesions, increased secretions, and increased mucosal edema are typically seen in late-phase reactions as part of the inflammatory response that occurs later. Therefore, rapid bronchospasms are most indicative of an early-phase reaction.

4. A child presents to the emergency department with colicky abdominal pain in the lower right quadrant. What disorder is suspected based on these symptoms?

• A. Peritonitis
• B. Appendicitis
• C. Intussusception
• D. Hirschsprung's disease

Correct answer: B

Rationale: The child's presentation of colicky abdominal pain in the lower right quadrant is classic for appendicitis. Appendicitis typically presents with localized pain that starts near the umbilicus and then shifts to the right lower quadrant. Peritonitis, on the other hand, is characterized by diffuse abdominal pain, tenderness, and guarding, usually resulting from organ perforation or intestinal obstruction. Intussusception is associated with acute, severe abdominal pain and currant jelly-like stools due to intestinal telescoping. Hirschsprung's disease, which lacks ganglion cells in the colon, manifests with symptoms like constipation, abdominal distension, and foul-smelling, ribbon-like stools.

5. A patient is being discharged from the med-surgical unit. The patient has a history of gastritis. The nurse questions the patient on their usual routine at home. Which of these statements would alert the nurse that additional teaching is required?

• A. I avoid NSAIDs. I only take a daily aspirin for my heart health.
• B. I always avoid eating hot and spicy foods.
• C. I will continue taking my antacids with or immediately after meals.
• D. I will only drink coffee once a week, if even that often.

Correct answer: A

Rationale: The correct answer is, 'I avoid NSAIDs. I only take a daily aspirin for my heart health.' Aspirin is classified as an NSAID and can exacerbate existing stomach problems, such as gastritis. Therefore, patients with gastritis should avoid aspirin just like any other NSAID. Choice B, 'I always avoid eating hot and spicy foods,' is a good practice for a patient with gastritis. Choice C, 'I will continue taking my antacids with or immediately after meals,' indicates understanding of the correct timing for antacid use. Choice D, 'I will only drink coffee once a week, if even that often,' shows a suitable limitation of coffee intake, which is beneficial for patients with gastritis.

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