Nursing Elites

1. A patient with acute dyspnea is scheduled for a spiral computed tomography (CT) scan. Which information obtained by the nurse is a priority to communicate to the health care provider before the CT?

• A. Allergy to shellfish
• B. Apical pulse of 104
• C. Respiratory rate of 30
• D. Oxygen saturation of 90%

Correct answer: A

Rationale: Because iodine-based contrast media is used during a spiral CT, the patient may need to have the CT scan without contrast or be premedicated before injection of the contrast media. The increased pulse, low oxygen saturation, and tachypnea all indicate a need for further assessment or intervention but do not indicate a need to modify the CT procedure.

2. For a 6-year-old child hospitalized with moderate edema and mild hypertension associated with acute glomerulonephritis (AGN), which one of the following nursing interventions would be appropriate?

• A. Institute seizure precautions
• B. Weigh the child twice per shift
• C. Encourage the child to eat protein-rich foods
• D. Relieve boredom through physical activity

Correct answer: A

Rationale: Institute seizure precautions. The severity of the acute phase of AGN is variable and unpredictable; therefore, a child with edema, hypertension, and gross hematuria may be subject to complications, and anticipatory preparation such as seizure precautions is needed. Weighing the child twice per shift may be necessary for monitoring fluid balance but is not specifically related to the complications of AGN. Encouraging the child to eat protein-rich foods is important for overall nutrition but does not directly address the potential complications of AGN. Relieving boredom through physical activity is beneficial for overall well-being but is not the priority in this situation where seizure precautions are essential.

3. A nurse caring for several patients in the cardiac unit is told that one is scheduled for implantation of an automatic internal cardioverter-defibrillator. Which of the following patients is most likely to have this procedure?

• A. A patient admitted for myocardial infarction without cardiac muscle damage.
• B. A postoperative coronary bypass patient, recovering on schedule.
• C. A patient with a history of ventricular tachycardia and syncopal episodes.
• D. A patient with a history of atrial tachycardia and fatigue.

Correct answer: C

Rationale: The correct answer is a patient with a history of ventricular tachycardia and syncopal episodes. An automatic internal cardioverter-defibrillator is used to deliver an electric shock to the heart to terminate episodes of ventricular tachycardia and ventricular fibrillation. These patients are at high risk of life-threatening arrhythmias, which may result in syncope. Patients with atrial tachycardia and fatigue (Choice D) would not typically require an implantable cardioverter-defibrillator as their primary issue is related to atrial arrhythmias. Patients who have had a myocardial infarction without cardiac muscle damage (Choice A) or postoperative coronary bypass patients recovering on schedule (Choice B) are not necessarily at high risk for ventricular arrhythmias and would not be the primary candidates for an implantable cardioverter-defibrillator.

4. A client presents with symptoms of a sore throat, swollen lymph nodes in the neck, fever, chills, and extreme fatigue. Based on these symptoms, which of the following illnesses could the nurse consider for this client?

• A. Methicillin-resistant Staphylococcus aureus (MRSA)
• B. Hepatitis B
• C. Infectious mononucleosis
• D. Norovirus infection

Correct answer: C

Rationale: Infectious mononucleosis is a viral disease caused by the Epstein-Barr virus. The symptoms of sore throat, fever, chills, swollen lymph nodes, and extreme fatigue are characteristic of infectious mononucleosis. The diagnosis is confirmed through the client's history and blood tests for the Epstein-Barr virus. Methicillin-resistant Staphylococcus aureus (MRSA) presents with localized skin infections, not the systemic symptoms described. Hepatitis B typically presents with jaundice, abdominal pain, and liver inflammation, not the symptoms described. Norovirus infection commonly causes gastrointestinal symptoms like vomiting and diarrhea, not the symptoms presented by the client.

5. An infant weighed 7 pounds 8 ounces at birth. If growth occurs at a normal rate, what would be the expected weight at 6 months of age?

• A. Double the birth weight
• B. Triple the birth weight
• C. Gain 6 ounces each week
• D. Add 2 pounds each month

Correct answer: A

Rationale: Infants typically double their birth weight by 6 months of age as part of normal growth and development. This doubling of weight is a common milestone used by healthcare providers to assess a baby's growth progress. Tripling the birth weight or adding 2 pounds each month would result in excessive weight gain, which is not typical or healthy for an infant. Similarly, gaining 6 ounces each week would also lead to rapid and abnormal weight gain, making it an incorrect choice.

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