Nursing Elites

1. A 4-year-old client with intractable seizures has been on a ketogenic diet for the last 6 months, with a decrease in seizure activity. This child is now admitted to the pediatric unit with left-sided pain. Which possible complication to this diet does the nurse suspect?

• A. Appendicitis
• B. Bowel obstruction
• C. Urinary tract infection
• D. Kidney stones

Correct answer: D

Rationale: The ketogenic diet increases the risk of kidney stones.

2. A preschool-age child is admitted to the hospital with acute postinfectious glomerulonephritis (APIGN). Which is the priority nursing diagnosis for this child?

• A. Risk for Injury related to hypertension.
• B. Altered Growth and Development related to chronic disease.
• C. Risk for Infection related to hypertension.
• D. Fluid Volume Excess related to decreased plasma filtration.

Correct answer: A

Rationale: The priority nursing diagnosis for a preschool-age child with acute postinfectious glomerulonephritis (APIGN) is 'Risk for Injury related to hypertension' due to the potential complications such as hypertensive encephalopathy. Hypertension poses an immediate threat to the child's well-being, making it crucial to address the risk for injury associated with elevated blood pressure as the top priority.

3. Following a child's return from exploratory surgery due to a gunshot wound to the abdomen, which nursing intervention should be excluded from the plan of care?

• A. Immediate initiation of oral feedings
• B. Assessment of the surgical site
• C. Administration of opioid narcotics for pain management
• D. Visitation at the bedside

Correct answer: A

Rationale: Immediate initiation of oral feedings should be excluded from the plan of care post-abdominal surgery due to the risk of bowel complications like paralytic ileus or anastomotic leak. Starting oral feedings immediately can increase these risks and hinder healing. It is crucial to wait until bowel function returns and the patient shows signs of tolerance before introducing oral feedings. Assessment of the surgical site is necessary to monitor for any signs of infection or complications. Administration of opioid narcotics for pain management is essential for ensuring the patient's comfort post-surgery. Visitation at the bedside provides emotional support and can aid in the patient's recovery. Therefore, the correct answer is to exclude immediate initiation of oral feedings.

4. What is the most important statement to include when teaching a patient who is prescribed metronidazole (Flagyl)?

• A. Take the medication with food.
• B. Avoid alcohol consumption.
• C. If you experience a metallic taste in your mouth, call your doctor.
• D. You can stop taking the medication once you feel better.

Correct answer: B

Rationale: The most crucial statement to include when teaching a patient prescribed metronidazole (Flagyl) is to avoid alcohol consumption. Mixing metronidazole and alcohol can lead to a disulfiram-like reaction, causing severe symptoms such as nausea, vomiting, and headache. Therefore, it is essential to emphasize to the patient the importance of abstaining from alcohol while taking this medication to prevent adverse reactions.

5. The mother of a 5-year-old child taking prednisone for nephrotic syndrome tells the nurse he needs to get immunizations to enter kindergarten. What does the nurse clarify about receiving immunizations while on prednisone?

• A. Can interfere with the treatment for nephrosis.
• B. Require that the child have antibiotic coverage.
• C. Can be given in smaller, divided doses.
• D. Should be delayed.

Correct answer: D

Rationale: No vaccinations or immunizations should be administered while the disease is active and during immunosuppressive therapy.

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