Nursing Elites

1. A home care nurse instructs the mother of a 5-year-old child with lactose intolerance about dietary measures for her child. The nurse should tell the mother that it is necessary to provide which dietary supplement in the child's diet?

• A. Fats
• B. Zinc
• C. Protein
• D. Calcium

Correct answer: D

Rationale: In lactose intolerance, the inability to digest lactose, the sugar in dairy products, can lead to calcium deficiency if dairy products are removed from the diet. Calcium is crucial for bone health and other bodily functions, so alternative calcium sources like fortified non-dairy milks or leafy greens must be included to prevent deficiency. While fats and proteins are important nutrients, they are not typically deficient in lactose intolerance. Zinc, although an essential mineral, is not the primary concern in this case.

2. Which patient poses the least infection risk to an immunosuppressed patient who had a liver transplant?

• A. The patient with chronic pancreatitis
• B. The patient currently infected with a respiratory virus
• C. The patient with a healing leg wound
• D. The patient with a urinary tract infection

Correct answer: C

Rationale: The patient with a healing leg wound poses the least infection risk to an immunosuppressed patient who had a liver transplant. Chronic pancreatitis can lead to complications such as infections that can pose a risk to immunosuppressed individuals. Patients infected with respiratory viruses or urinary tract infections are actively infectious, which can put immunosuppressed patients at a higher risk of acquiring infections. Therefore, the patient with a healing leg wound is the least likely to pose an immediate infection risk.

3. A patient in metabolic alkalosis is admitted to the emergency department, and pulse oximetry indicates that the O2 saturation is 94%. Which action should the nurse take next?

• A. Administer bicarbonate.
• B. Complete a head-to-toe assessment.
• C. Place the patient on high-flow oxygen.
• D. Obtain repeat arterial blood gases (ABGs).

Correct answer: C

Rationale: In a patient with metabolic alkalosis and an O2 saturation of 94%, placing the patient on high-flow oxygen is the correct action. Even though the O2 saturation seems adequate, metabolic alkalosis causes a left shift in the oxyhemoglobin dissociation curve, reducing oxygen delivery to tissues. Therefore, providing high-flow oxygen can help compensate for this. Administering bicarbonate would exacerbate the alkalosis. While completing a head-to-toe assessment and obtaining repeat ABGs are important interventions, the priority in this scenario is to improve oxygen delivery by placing the patient on high-flow oxygen.

4. Following surgery to correct cryptorchidism, what is the priority action that the nurse should include in the plan of care?

• A. Prevent tension on the suture.
• B. Monitor urine for glucose and acetone.
• C. Encourage oral fluids, and monitor intake and output.
• D. Encourage coughing and deep breathing every hour.

Correct answer: A

Rationale: The correct answer is to prevent tension on the suture. After surgery for cryptorchidism, the testicle is held in position by an internal suture that should not be dislodged. Immobilization of the area for a week is crucial to prevent complications like bleeding and infection. Monitoring urine for glucose and acetone is unrelated to this surgery. While maintaining hydration is important, forcing fluids is not necessary. Encouraging coughing and deep breathing every hour may be a postoperative consideration, but it is not the priority for this specific surgery.

5. A 4-year-old child with acute glomerulonephritis is admitted to the hospital. The nurse identifies which client problem in the plan of care as the priority?

• A. Infection related to hypertension
• B. Injury related to loss of blood in urine
• C. Excessive fluid volume related to decreased plasma filtration
• D. Retarded growth and development related to a chronic disease

Correct answer: C

Rationale: In acute glomerulonephritis, the child experiences excessive accumulation of water and retention of sodium, leading to circulatory congestion and edema. Excessive fluid volume is a primary concern due to the disease process. Hypertension and infection are not directly related to acute glomerulonephritis; therefore, they are not the priority client problems. While hematuria (blood in urine) may occur, it typically does not lead to significant injury that takes precedence over excessive fluid volume. Acute glomerulonephritis is an acute condition, not chronic; therefore, retarded growth and development related to a chronic disease is not the priority issue. With proper management, most children recover completely without long-term growth and development issues.

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