Nursing Elites

1. A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely for which problem?

• A. Diarrhea
• B. Metabolic acidosis
• C. Metabolic alkalosis
• D. Hyperactive bowel sounds

Correct answer: C

Rationale: In the scenario of persistent vomiting, the child is at risk of developing metabolic alkalosis due to the loss of hydrochloric acid. Vomiting leads to the loss of gastric acid, resulting in an imbalance that causes metabolic alkalosis. Metabolic acidosis is incorrect as it would occur in a child with diarrhea due to the loss of bicarbonate. While diarrhea can sometimes be associated with vomiting, in this case, the primary focus is on the effects of vomiting. Hyperactive bowel sounds are not typically associated with vomiting, making this choice less relevant to the situation described.

2. To prepare a 56-year-old male patient with ascites for paracentesis, the nurse should?

• A. place the patient on NPO status.
• B. assist the patient to lie flat in bed.
• C. ask the patient to empty the bladder.
• D. position the patient on the right side.

Correct answer: C

Rationale: To prepare a patient with ascites for paracentesis, the nurse should ask the patient to empty the bladder. This is important to decrease the risk of bladder perforation during the procedure. The patient should be positioned in Fowler's position to facilitate the procedure, not lie flat in bed, which can compromise breathing. Placing the patient on NPO status is unnecessary as sedation is not typically required for paracentesis. Positioning the patient on the right side is not a standard preparatory measure for paracentesis.

3. When developing a plan of care for a 6-year-old child diagnosed with acute glomerulonephritis, which intervention should the nurse prioritize?

• A. Encourage limited activity and provide safety measures.
• B. Catheterize the child to monitor intake and output strictly.
• C. Encourage the child to talk about feelings related to illness.
• D. Encourage classmates to visit and keep the child informed of school events.

Correct answer: A

Rationale: The priority intervention for a 6-year-old child diagnosed with acute glomerulonephritis should be to encourage limited activity and provide safety measures. In glomerulonephritis, children tend to restrict their activities voluntarily due to fatigue during the active phase of the disease. Catheterization for intake and output monitoring may predispose the child to infection and is not the primary intervention. Encouraging the child to talk about feelings related to the illness may not be developmentally appropriate for a 6-year-old; instead, children can express feelings through play. It is important to limit visitors to allow the child to rest and recover rather than encouraging classmates to visit and keep the child informed of school events.

4. Which playroom activities should the nurse organize for a small group of 7-year-old hospitalized children?

• A. Sports and games with rules
• B. Finger paints and water play
• C. Dress-up clothes and props
• D. Chess and television programs

Correct answer: A

Rationale: The correct answer is 'Sports and games with rules.' For 7-year-old children, organized activities that involve rules are beneficial as they promote cooperation, logical reasoning, and the development of social skills. Sports and games with rules help children understand the importance of following guidelines, playing fairly, and working together towards a common goal. Finger paints and water play (choice B) may be more suitable for younger children and may not fully engage 7-year-olds in the same way that structured games would. Dress-up clothes and props (choice C) primarily encourage imaginative play but may not emphasize the same level of cooperation and rule-following as sports and games. Chess and television programs (choice D) may not be as interactive or physically engaging as sports and games, limiting the opportunities for social interaction and cooperation among the children.

5. The mother of a child with hepatitis A tells the home care nurse that she is concerned because the child's jaundice seems worse. What is the nurse's best response?

• A. You need to change the child's diet.
• B. The child probably is infectious again.
• C. The jaundice may worsen before it resolves.
• D. You need to call the primary health care provider.

Correct answer: C

Rationale: The best response for the nurse in this situation is to explain to the mother that jaundice may seem to worsen before it eventually gets better. This is a common occurrence in hepatitis A. Option A about changing the child's diet is irrelevant to the concern raised by the mother and not supported by evidence. Option B suggesting the child is infectious again is incorrect and may cause unnecessary alarm as jaundice does not indicate reinfection. Option D, advising the mother to call the primary health care provider, is premature as the nurse can first provide education and reassurance regarding the expected course of jaundice in hepatitis A.

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