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. A 34-year-old patient with chronic hepatitis C infection has several medications prescribed. Which medication requires further discussion with the healthcare provider before administration?

• A. Ribavirin (Rebetol, Copegus) 600 mg PO bid
• B. Pegylated ?-interferon (PEG-Intron, Pegasys) SQ weekly
• C. Diphenhydramine (Benadryl) 25 mg PO every 4 hours PRN itching
• D. Dimenhydrinate (Dramamine) 50 mg PO every 6 hours PRN nausea

Correct answer: B

Rationale: The correct answer is B: Pegylated ?-interferon (PEG-Intron, Pegasys) SQ weekly. Pegylated ?-interferon is typically administered once weekly, not daily. Therefore, this medication requires further discussion with the healthcare provider before administration to ensure the correct dosing frequency. Ribavirin, choice A, is appropriate for chronic hepatitis C treatment. Choices C and D, Diphenhydramine and Dimenhydrinate, are commonly used for symptomatic relief in patients with hepatitis C and do not require further discussion with the healthcare provider in this context.

3. A 3-year-old child is seen in the health care clinic, and a diagnosis of encopresis is made. The nurse expects to provide teaching about which client problem?

• A. Odor
• B. Nausea
• C. Malaise
• D. Diarrhea

Correct answer: A

Rationale: Encopresis is the repeated voluntary or involuntary passage of feces of normal or near-normal consistency in places not appropriate for that purpose according to the individual's own sociocultural setting. Signs of encopresis include evidence of soiled clothing, scratching or rubbing the anal area due to irritation, fecal odor without apparent awareness by the child, and social withdrawal. Teaching about odor is essential to address the issue of encopresis. Choices B, C, and D are incorrect because encopresis is not typically associated with nausea, malaise, or diarrhea. Therefore, teaching about these symptoms would not be relevant in the context of encopresis.

4. The nurse is performing a neurological assessment on a client post right cerebrovascular accident. Which finding, if observed by the nurse, would warrant immediate attention?

• A. Decrease in level of consciousness
• B. Loss of bladder control
• C. Altered sensation to stimuli
• D. Emotional lability

Correct answer: A

Rationale: A decrease in the level of consciousness is a critical finding that would warrant immediate attention in a client post right cerebrovascular accident. This change may indicate an increase in intracranial pressure, leading to inadequate oxygenation of the brain. It could also reveal the presence of a transient ischemic attack, which may signal an impending thrombotic cerebrovascular accident. Loss of bladder control (choice B) can be managed and monitored but does not indicate an immediate threat to the client's life. Altered sensation to stimuli (choice C) can be a concerning finding but may not require immediate attention unless it affects the client's safety. Emotional lability (choice D) may be distressing for the client but does not pose an immediate risk to their health compared to a decrease in the level of consciousness.

5. A 16-month-old child has just been admitted to the hospital. As the nurse assigned to this child enters the hospital room for the first time, the toddler runs to the mother, clings to her, and begins to cry. What would be the initial action by the nurse?

• A. Arrange to change client care assignments
• B. Explain that this behavior is expected
• C. Discuss the appropriate use of 'time-out'
• D. Explain that the child needs extra attention

Correct answer: B

Rationale: When encountering a 16-month-old child exhibiting fear of strangers by clinging to the parent and crying, it is essential for the nurse to explain that this behavior is expected. Fear of strangers typically emerges around 6-8 months of age and can continue into the toddler years and beyond. This behavior is a normal part of development as the child is displaying attachment and trust in familiar caregivers. Changing client care assignments, discussing 'time-out,' or suggesting the child needs extra attention are not appropriate initial actions in this situation. Changing care assignments is unnecessary and does not address the child's emotional needs. Discussing 'time-out' is not relevant as it pertains to discipline strategies for older children. Suggesting the child needs extra attention may misinterpret the situation; the child's behavior is a normal response to a new environment and does not necessarily indicate a need for additional attention.

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