Nursing Elites

1. A 10-year-old child is admitted with diabetic ketoacidosis (DKA). Which laboratory value should the practical nurse (PN) anticipate?

• A. Elevated blood glucose.
• B. Decreased serum ketones.
• C. Low urine glucose.
• D. High bicarbonate levels.

Correct answer: A

Rationale: In a case of diabetic ketoacidosis (DKA), the primary feature is elevated blood glucose levels due to insulin deficiency. Additionally, ketones are increased in the blood and urine. Bicarbonate levels are usually low because of the metabolic acidosis that accompanies DKA. Therefore, the practical nurse should anticipate elevated blood glucose levels as a characteristic laboratory finding in a child admitted with DKA. Choice B is incorrect because serum ketones are increased in DKA. Choice C is incorrect because in DKA, urine glucose is typically high due to spillage of glucose into the urine. Choice D is incorrect because bicarbonate levels are usually low in DKA, not high.

2. When reviewing developmental changes with the parents of a 6-month-old infant, what information should the practical nurse reinforce?

• A. Encourage the infant to self-feed finger foods.
• B. Teach the parents strategies to help the infant sit up.
• C. Provide a developmentally safe environment for the infant.
• D. Explain that an increased appetite typically occurs in the next 6 months.

Correct answer: C

Rationale: The correct answer is C because providing a developmentally safe environment for a 6-month-old infant is crucial as they begin to explore their surroundings more actively. This includes ensuring that the environment is free of hazards and that the infant is supervised to prevent accidents. Choice A is incorrect because self-feeding finger foods may not be developmentally appropriate for a 6-month-old infant. Choice B is incorrect as most infants are able to sit up with support around 6 months of age without the need for specific teaching strategies. Choice D is also incorrect as while appetite changes can occur, explaining a specific increase in appetite over the next 6 months is not a primary focus when discussing developmental changes with parents of a 6-month-old.

3. The nurse provides information about the human papillomavirus (HPV) vaccine to the mother of a 14-year-old adolescent who came to the clinic this morning complaining of menstrual cramping. Which explanation should the nurse provide to support administering the HPV vaccine to the adolescent at this visit?

• A. Use of protective barriers during sexual activity prevents most strains of HPV infection
• B. Most adolescents are not honest about being sexually active
• C. Not all strains of HPV will be covered if given at a later date
• D. Immunity must be established to prevent future HPV infection and the risk for cervical cancer

Correct answer: D

Rationale: Administering the HPV vaccine helps establish immunity before potential exposure to the virus, reducing the risk of HPV infection and subsequent development of cervical cancer. It is recommended to vaccinate adolescents before they become sexually active for maximum effectiveness. Choice A is incorrect because while protective barriers can reduce the risk, they do not prevent all strains of HPV. Choice B is incorrect and judgmental as it assumes dishonesty without providing relevant information about HPV vaccination. Choice C is incorrect as it downplays the importance of vaccination by suggesting that not all strains are necessary to cover, which is not the case in preventing HPV-related diseases.

4. When should the surgical correction of hypospadias in a newborn infant typically be done?

• A. Repair should be done by one month to prevent bladder infection.
• B. To form a proper urethra repair, it should be done after sexual maturity.
• C. Repairs typically should be done before the child is potty trained.
• D. Delaying the repair until school age reduces castration fears.

Correct answer: C

Rationale: Surgical repairs for hypospadias are typically recommended to be performed before the child is potty trained. This timing helps in avoiding complications, ensures better outcomes, and makes the surgical process smoother. Early correction also minimizes the psychological impact on the child regarding genital differences and can improve long-term psychological well-being. Choices A, B, and D are incorrect because repairing hypospadias at one month to prevent bladder infection, after sexual maturity to form a proper urethra, or delaying the repair until school age to reduce castration fears are not the standard recommendations. The optimal timing for surgical correction is before the child is potty trained to achieve the best results and psychological outcomes.

5. The nurse determines that an infant admitted for surgical repair of an inguinal hernia voids a urinary stream from the ventral surface of the penis. What action should the nurse take?

• A. Document the finding
• B. Palpate scrotum for testicular descent
• C. Assess for bladder distension
• D. Auscultate bowel sounds

Correct answer: A

Rationale: The correct action for the nurse to take in this situation is to document the finding. The infant voiding a urinary stream from the ventral surface of the penis suggests hypospadias, a condition where the urethral opening is on the underside of the penis. This finding is crucial information that needs to be documented for further evaluation. Palpating the scrotum for testicular descent, assessing for bladder distension, and auscultating bowel sounds are not appropriate actions based on the presented scenario and do not address the specific concern of the urinary stream location.

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