Nursing Elites

1. A 7-year-old child is seen in a clinic, and the pediatrician documents a diagnosis of nighttime (nocturnal) enuresis. What information should the nurse provide to the parents?

• A. Nighttime (nocturnal) enuresis does not respond to treatment.
• B. Nighttime (nocturnal) enuresis is caused by a psychiatric problem.
• C. Nighttime (nocturnal) enuresis requires surgical intervention to improve the problem.
• D. Nighttime (nocturnal) enuresis is usually outgrown without therapeutic intervention.

Correct answer: D

Rationale: Nighttime (nocturnal) enuresis is common in children and is characterized by a child who has never been dry at night for extended periods. Most children eventually outgrow bedwetting without therapeutic intervention. This condition is due to the child being unable to sense a full bladder and not awakening to void, often related to delayed maturation of the central nervous system. It is important for parents to understand that nighttime (nocturnal) enuresis is not caused by a psychiatric problem, does not typically require surgical intervention, and usually resolves on its own over time.

2. Which information about a 60-year-old patient with MS indicates that the nurse should consult with the healthcare provider before giving the prescribed dose of dalfampridine (Ampyra)?

• A. The patient has relapsing-remitting MS
• B. The patient walks a mile a day for exercise
• C. The patient complains of pain with neck flexion
• D. The patient has an increased serum creatinine level

Correct answer: D

Rationale: The correct answer is that the patient has an increased serum creatinine level. Dalfampridine should not be given to patients with impaired renal function as it can worsen their condition. Options A, B, and C are unrelated to the administration of dalfampridine. The fact that the patient has relapsing-remitting MS, walks for exercise, or experiences neck pain does not directly impact the decision to administer dalfampridine. However, an increased serum creatinine level is a contraindication for this medication and requires consultation with the healthcare provider to determine the appropriate course of action.

3. A home health nurse is at the home of a client with diabetes and arthritis. The client has difficulty drawing up insulin. It would be most appropriate for the nurse to refer the client to

• A. A social worker from the local hospital
• B. An occupational therapist from the community center
• C. A physical therapist from the rehabilitation agency
• D. Another client with diabetes mellitus who takes insulin

Correct answer: B

Rationale: An occupational therapist from the community center would be the most appropriate referral for this client. Occupational therapists specialize in helping individuals improve fine motor skills, which are essential for tasks like drawing up insulin injections. A social worker typically focuses on psychosocial aspects, a physical therapist on physical mobility, and another client with diabetes would not have the professional expertise to address the client's specific needs related to insulin preparation.

4. A man has been taking lisinopril for CHF. The patient is seen in the emergency room for persistent diarrhea. The nurse is concerned about which side effect of lisinopril?

• A. Vertigo
• B. Hypotension
• C. Palpitations
• D. Nagging, dry cough

Correct answer: B

Rationale: The correct answer is 'Hypotension.' Lisinopril, an ACE inhibitor commonly used for CHF, can cause hypotension as a side effect. Persistent diarrhea can lead to dehydration, increasing the risk of hypotension in this patient. Vertigo (choice A) is not a typical side effect of lisinopril. Palpitations (choice C) are not directly associated with lisinopril use. A nagging, dry cough (choice D) is a common side effect of ACE inhibitors like lisinopril, but in this case, the patient's presentation with persistent diarrhea would make hypotension a more immediate concern.

5. A patient is admitted to the hospital with a diagnosis of primary hyperparathyroidism. A nurse checking the patient's lab results would expect which of the following changes in laboratory findings?

• A. Elevated serum calcium
• B. Low serum parathyroid hormone (PTH)
• C. Elevated serum vitamin D
• D. Low urine calcium

Correct answer: A

Rationale: In primary hyperparathyroidism, there is excess secretion of parathyroid hormone (PTH) leading to increased resorption of calcium from bones and decreased excretion of calcium by the kidneys. This results in elevated serum calcium levels. Elevated serum calcium is a hallmark characteristic of primary hyperparathyroidism, making it the correct answer. Low serum parathyroid hormone (PTH) (Choice B) is incorrect because primary hyperparathyroidism is associated with elevated PTH levels due to the malfunction of the parathyroid glands. Elevated serum vitamin D (Choice C) is incorrect because primary hyperparathyroidism is not typically associated with elevated vitamin D levels. Low urine calcium (Choice D) is incorrect as primary hyperparathyroidism leads to decreased calcium excretion by the kidneys, resulting in high levels of calcium in the urine.

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