Nursing Elites

1. A client in the ICU has been intubated and placed on a ventilator. The physician orders synchronous intermittent mandatory ventilation (SIMV). Which statement best describes the work of this mode of ventilation?

• A. The ventilator delivers a set rate and tidal volume regardless of whether the client is attempting to breathe
• B. The ventilator coordinates delivered breaths with the client's respiratory efforts
• C. The ventilator provides a supplemental breath for every third breath of the client
• D. The ventilator provides breaths during the expiratory phase of the client's respirations

Correct answer: B

Rationale: Synchronous intermittent mandatory ventilation (SIMV) is a ventilation mode that coordinates delivered breaths with the client's own respiratory efforts. This mode allows the client to initiate breaths, with the ventilator providing preset breaths at a controlled rate and volume. Option A is incorrect because in SIMV, the ventilator syncs with the client's respiratory efforts. Option C is incorrect as it does not accurately depict the way SIMV works. Option D is also incorrect as SIMV does not specifically provide breaths during the expiratory phase of the client's respirations. Therefore, the correct answer is B, where the ventilator coordinates breath delivery with the client's breathing efforts.

2. The nurse provides discharge instructions to a patient who was hospitalized for pneumonia. Which statement, if made by the patient, indicates a good understanding of the instructions?

• A. I will call the doctor if I still feel tired after a week.
• B. I will continue to do the deep breathing and coughing exercises at home.
• C. I will continue to do the deep breathing and coughing exercises at home.
• D. I'll cancel my chest x-ray appointment if Im feeling better in a couple weeks

Correct answer: C

Rationale: Patients should continue to cough and deep breathe after discharge. Fatigue is expected for several weeks. The Pneumovax and influenza vaccines can be given at the same time in different arms. Explain that a follow-up chest x-ray needs to be done in 6 to 8 weeks to evaluate resolution of pneumonia.

3. 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.

4. The nurse is preparing to care for an infant who has esophageal atresia with tracheoesophageal fistula. Surgery is scheduled to be performed in 1 hour. Intravenous fluids have been initiated, and a nasogastric (NG) tube has been inserted by the primary healthcare provider. The nurse plans care, knowing that which intervention is of highest priority during this preoperative period?

• A. Monitor the temperature.
• B. Monitor the blood pressure.
• C. Reposition the infant frequently.
• D. Aspirate the NG tube every 5 to 10 minutes.

Correct answer: D

Rationale: Esophageal atresia with tracheoesophageal fistula is a critical neonatal surgical emergency. The highest priority intervention during the preoperative period is to aspirate the NG tube every 5 to 10 minutes to keep the proximal pouch clear of secretions and prevent aspiration. This is crucial in reducing the risk of gastric secretions entering the lungs. Repositioning the infant frequently is not as critical as ensuring the NG tube is aspirated. Monitoring the temperature and blood pressure are important nursing interventions but are not the highest priority in this situation. It is essential to prioritize airway protection and prevent aspiration in this neonate undergoing urgent surgical intervention.

5. The clinic nurse is obtaining data about a child with a diagnosis of lactose intolerance. Which data should the nurse expect to obtain on assessment?

• A. Reports of frothy stools and diarrhea
• B. Reports of foul-smelling ribbon stools
• C. Reports of profuse, watery diarrhea and vomiting
• D. Reports of diffuse abdominal pain unrelated to meals or activity

Correct answer: A

Rationale: Lactose intolerance commonly presents with frothy stools and diarrhea due to the inability to digest lactose. Other symptoms include abdominal distension, crampy abdominal pain, and excessive flatus. Foul-smelling ribbon stools are indicative of Hirschsprung's disease, not lactose intolerance. Profuse, watery diarrhea and vomiting are more characteristic of celiac disease. Diffuse abdominal pain unrelated to meals or activity is a typical symptom of irritable bowel syndrome, not lactose intolerance.

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