Nursing Elites

1. A client who is receiving general anesthesia begins to demonstrate symptoms of malignant hyperthermia. Which intervention should the perioperative nurse prepare to implement first?

• A. Ensure patency of an indwelling catheter and measure hourly intake and output.
• B. Prepare for cessation of the anesthesia and the surgical procedure.
• C. Obtain specimens of ABGs and serum electrolytes.
• D. Initiate cooling measures using iced normal saline by nasogastric lavage.

Correct answer: B

Rationale: The correct answer is B: Prepare for cessation of the anesthesia and the surgical procedure. Malignant hyperthermia is a severe reaction to certain medications used during general anesthesia. The immediate intervention to manage malignant hyperthermia is to stop the triggering agents, which include anesthesia and surgery. Ensuring patency of an indwelling catheter and measuring intake and output, obtaining specimens of ABGs and serum electrolytes, and initiating cooling measures are important interventions but should follow the immediate action of stopping the anesthesia and surgery to address the life-threatening condition of malignant hyperthermia.

2. A client with type 1 diabetes mellitus is experiencing nausea and vomiting. What is the most important instruction the nurse should provide?

• A. Stop taking insulin until feeling better
• B. Increase fluid intake to prevent dehydration
• C. Consume high-carbohydrate foods only
• D. Check blood glucose levels frequently

Correct answer: D

Rationale: The correct answer is to instruct the client to check blood glucose levels frequently. During illness, such as nausea and vomiting, managing blood glucose levels is crucial in clients with type 1 diabetes mellitus. Monitoring blood glucose levels frequently helps in adjusting insulin doses appropriately, preventing complications like hyperglycemia or hypoglycemia. Choice A is incorrect because stopping insulin abruptly can lead to serious complications. Choice B is important but not the most critical in this scenario. Choice C is incorrect as high-carbohydrate foods may further affect blood glucose levels negatively.

3. Which is a long-term complication of cleft lip and palate?

• A. Cognitive impairment
• B. Altered growth and development
• C. Faulty dentition
• D. Physical abilities

Correct answer: C

Rationale: The correct answer is C, 'Faulty dentition.' The older child with cleft lip and palate may experience psychological difficulties due to the cosmetic appearance of the defect, issues with impaired speech, and faulty dentition. This can lead to problems with dental alignment, crowding, missing or malformed teeth, and other dental issues. Choices A, B, and D are incorrect as cognitive impairment, altered growth and development, and physical abilities are not typically considered long-term complications of cleft lip and palate.

4. The nurse instructs the mother of a child with a ventricular septal defect that she can expect the child to become cyanotic when the child does what?

• A. Experiences an elevation in temperature.
• B. Sleeps on the left side.
• C. Cries vigorously.
• D. Eats.

Correct answer: C

Rationale: The correct answer is C: Cries vigorously. When the child cries vigorously, it increases the pressure in the right ventricle, allowing unoxygenated blood to enter the circulating volume, leading to cyanosis. This occurs due to the shunting of blood from the right side of the heart to the left side through the ventricular septal defect. Choices A, B, and D are incorrect because they do not directly impact the pressure in the right ventricle, which is crucial in causing cyanosis in this scenario.

5. Parents of a 5-year-old child diagnosed with cognitive impairment have come to the nurse to discuss different approaches to the ongoing care of their child. The nurse should suggest focusing on what activity?

• A. Acquiring job skills
• B. Making decisions
• C. Performing self-care activities
• D. Reading and doing simple math

Correct answer: C

Rationale: The correct answer is C: Performing self-care activities. For a 5-year-old child diagnosed with cognitive impairment, it is crucial to focus on teaching them basic self-care skills. This includes activities like dressing themselves, feeding, and personal hygiene. These skills are fundamental for their daily living and independence. Choices A, B, and D are not appropriate for a young child with cognitive impairment. Acquiring job skills is not developmentally suitable at this age, making decisions may be challenging due to cognitive limitations, and reading and doing simple math may be too advanced for their current cognitive abilities.

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