Nursing Elites

1. A 10-month-old child is brought to the Emergency Department because he is difficult to awaken. The nurse notes bruises on both upper arms. These findings are most consistent with

• A. wearing clothing that is too small for the child
• B. the child being shaken
• C. falling while learning to walk
• D. parents trying to awaken the child

Correct answer: B

Rationale: The correct answer is 'the child being shaken.' Children who are shaken are frequently grasped by both upper arms, leading to bruises in that area. The presentation of a difficult-to-awaken child with bruises on the upper arms is highly concerning for non-accidental trauma, such as abusive shaking. Symptoms of brain injury associated with shaking include a decreased level of consciousness. Choices A, C, and D are less likely because the combination of a child being difficult to awaken and bruises on both upper arms is highly suggestive of non-accidental trauma rather than benign causes like ill-fitting clothing, falling while learning to walk, or parents trying to awaken the child.

2. During a well-baby check of a 6-month-old infant, the nurse notes abrasions and petechiae of the palate. The nurse should:

• A. inquire about the possibility of sexual abuse.
• B. ask about the types of foods the child is eating.
• C. request to see the type of bottle used for feedings.
• D. question the parent about objects the child plays with.

Correct answer: A

Rationale: The correct answer is to inquire about the possibility of sexual abuse. Injuries to the soft palate such as bruising, abrasions, and petechiae can be signs of sexual abuse in infants. While oral sex may not leave significant physical evidence, these findings should raise suspicion. Option A is correct as it focuses on addressing potential abuse. Options B, C, and D are incorrect because the child's diet, the type of bottle used for feedings, and play objects are not likely related to the observed injuries. The presence of oral injuries suggests considering sexual abuse rather than other factors.

3. A 24-year-old female client is scheduled for surgery in the morning. What is the primary responsibility of the nurse?

• A. Taking the vital signs
• B. Obtaining the permit
• C. Explaining the procedure
• D. Checking the lab work

Correct answer: A

Rationale: The primary responsibility of the nurse is to take the vital signs before any surgery. This action helps assess the client's baseline condition and identify any abnormalities that need addressing before the procedure. Obtaining the permit (choice B) is typically handled by administrative staff, explaining the procedure (choice C) is usually done by the healthcare provider performing the surgery, and checking the lab work (choice D) is often part of the pre-operative assessment conducted by the healthcare provider. Therefore, in this context, these actions are not the primary responsibility of the nurse.

4. While the client is receiving total parenteral nutrition (TPN), which lab test should be evaluated?

• A. Hemoglobin
• B. Creatinine
• C. Blood glucose
• D. White blood cell count

Correct answer: C

Rationale: When a client is receiving total parenteral nutrition (TPN), monitoring blood glucose levels is crucial as TPN solutions contain high amounts of glucose. This monitoring helps prevent hyperglycemia or hypoglycemia. Evaluating hemoglobin (choice A) is not directly related to TPN administration. Creatinine (choice B) is more relevant for assessing kidney function. White blood cell count (choice D) is important for evaluating immune function and infection, but not specifically tied to TPN administration.

5. Which of the following post-operative diets is most appropriate for the client who has had a hemorrhoidectomy?

• A. High-fiber
• B. Low-residue
• C. Bland
• D. Clear-liquid

Correct answer: D

Rationale: The correct answer is 'Clear-liquid.' After a hemorrhoidectomy, the client is usually started on a clear-liquid diet to allow the intestines to rest and promote healing. This diet helps prevent straining during bowel movements, which is crucial for recovery. Stool softeners are often included in the plan to avoid constipation. Once the client tolerates the clear liquids well, they can progress to a regular diet. High-fiber diet (choice A) is beneficial in the later stages of recovery to prevent constipation but is not typically the initial post-operative diet. Low-residue diet (choice B) and bland diet (choice C) are not appropriate for this type of surgery as they may not provide the necessary post-operative care and support needed for healing.

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