Nursing Elites

1. A 6-year-old child is alert but quiet when brought to the emergency center with periorbital ecchymosis and ecchymosis behind the ears. The nurse suspects potential child abuse and continues to assess the child for additional manifestations of a basilar skull fracture. What assessment finding would be consistent with the basilar skull fracture?

• A. Blurred vision.
• B. Shoulder pain.
• C. Abdominal pain.
• D. Rhinorrhea or otorrhea with halo sign.

Correct answer: D

Rationale: The correct answer is D: Rhinorrhea or otorrhea with halo sign. Raccoon eyes (periorbital ecchymosis) and Battle's sign (ecchymosis behind the ear) are signs of a basilar skull fracture, indicating the need to assess for possible meningeal tears that manifest as a halo sign with cerebrospinal fluid (CSF) leakage from the ears or nose. Choices A, B, and C are incorrect because blurred vision, shoulder pain, and abdominal pain are not typically associated with a basilar skull fracture.

2. The nurse is preparing a teaching plan for a client who is newly diagnosed with hypothyroidism. Which instruction should the nurse include?

• A. Take levothyroxine (Synthroid) at bedtime.
• B. Increase fiber intake to prevent constipation.
• C. Take the medication on an empty stomach.
• D. Take a double dose if a dose is missed.

Correct answer: C

Rationale: The correct instruction for a client newly diagnosed with hypothyroidism is to take the medication on an empty stomach. This is important because taking levothyroxine on an empty stomach ensures better absorption of the medication. Choice A, taking levothyroxine at bedtime, is incorrect as it does not promote optimal absorption. Choice B, increasing fiber intake to prevent constipation, is important but not the priority when it comes to medication administration. Choice D, taking a double dose if a dose is missed, is dangerous and should never be advised as it can lead to overdose and serious side effects.

3. A community health nurse is planning an intervention to reduce the incidence of type 2 diabetes in the community. Which strategy is most effective?

• A. Hosting cooking classes on preparing healthy meals
• B. Offering free blood glucose screenings
• C. Distributing pamphlets on diabetes prevention
• D. Organizing a community walking program

Correct answer: A

Rationale: The most effective strategy to reduce the incidence of type 2 diabetes in the community is hosting cooking classes on preparing healthy meals. This intervention provides practical skills and education that can directly impact dietary habits, leading to a decreased risk of developing type 2 diabetes. Offering free blood glucose screenings (Choice B) may help in early detection but does not address prevention. Distributing pamphlets on diabetes prevention (Choice C) provides information but lacks the interactive and hands-on approach of cooking classes. Organizing a community walking program (Choice D) promotes physical activity, which is beneficial, but dietary changes have a more significant impact on preventing type 2 diabetes.

4. A client with a history of alcohol abuse is admitted with acute pancreatitis. Which laboratory result requires immediate intervention?

• A. Amylase of 120 U/L.
• B. Lipase of 150 U/L.
• C. Calcium of 8.5 mg/dL.
• D. Blood glucose of 250 mg/dL.

Correct answer: D

Rationale: The correct answer is D, 'Blood glucose of 250 mg/dL.' In a client with acute pancreatitis, elevated blood glucose levels can indicate poor control of diabetes or stress response from the acute illness. Immediate intervention is necessary to prevent complications like worsening pancreatitis, infections, or other metabolic issues. Choices A and B, 'Amylase of 120 U/L' and 'Lipase of 150 U/L,' are commonly elevated in pancreatitis but do not require immediate intervention unless significantly elevated. Choice C, 'Calcium of 8.5 mg/dL,' is within the normal range and not a priority in this scenario.

5. The healthcare provider is assessing a client who has a new arteriovenous fistula in the left arm for hemodialysis. Which finding requires immediate intervention?

• A. A thrill is palpable on the fistula.
• B. The client's arm is warm and red.
• C. The fistula has a bruit on auscultation.
• D. There is no bruit on auscultation.

Correct answer: B

Rationale: The correct answer is B. Warmth and redness in the client's arm suggest infection or thrombosis of the arteriovenous fistula, which requires immediate intervention to prevent complications. A thrill (A) is a normal finding in a functional arteriovenous fistula, indicating good blood flow. A bruit (C) is also a normal finding on auscultation of a functioning arteriovenous fistula, indicating proper blood flow. The absence of a bruit (D) may indicate a non-functioning fistula, which would need further evaluation but does not require immediate intervention as warmth and redness do.

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