Nursing Elites

1. A nurse administers naloxone (Narcan) to a post-op patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication?

• A. Drowsiness
• B. Tics and tremors
• C. Increased Pain
• D. Nausea and vomiting

Correct answer: C

Rationale: Naloxone reverses the effects of narcotics. Although the patient’s respiratory status will improve after administration of naloxone, the pain will be more acute.

2. Which question does not provide information regarding the family's cultural values?

• A. Who makes the decisions?
• B. What is the child's date of birth?
• C. What are the daily routines and rules of mealtime?
• D. What do the parents believe about disability?

Correct answer: B

Rationale: The correct answer is B. Asking for the child's date of birth is a factual question that does not directly relate to the family's cultural values. Choices A, C, and D delve into aspects that could offer insights into the family's cultural values and beliefs. Question A explores decision-making dynamics within the family, which can be influenced by cultural norms. Question C inquires about daily routines and mealtime rules, which often reflect cultural practices and values. Question D relates to the parents' beliefs about disability, which can be shaped by cultural, religious, or societal perspectives. Therefore, these questions are more likely to provide information about the family's cultural values compared to the child's date of birth.

3. When teaching a parent of a child with hemophilia, which of the following instructions should the nurse include?

• A. Administer aspirin for pain.
• B. Avoid administering NSAIDs.
• C. Restrict physical activities.
• D. Apply heat to joints.

Correct answer: B

Rationale: The correct answer is B: 'Avoid administering NSAIDs.' Hemophilia is a condition where blood does not clot properly. NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) can increase the risk of bleeding in individuals with hemophilia. Therefore, it is crucial for the parent to avoid giving their child NSAIDs for pain management to prevent exacerbating bleeding tendencies. Choice A is incorrect because aspirin, like NSAIDs, can also increase the risk of bleeding. Choice C is incorrect because physical activities should not be restricted but rather managed to prevent injuries that could lead to bleeding. Choice D is incorrect because applying heat to joints can worsen bleeding in individuals with hemophilia.

4. When receiving change-of-shift report for children, which child should the nurse assess first?

• A. A toddler who has a concussion and an episode of forceful vomiting
• B. An adolescent with infective endocarditis who reports having a headache
• C. An adolescent who was placed into Halo traction 1 hour ago and rates his pain at a 6 on a 0-10 scale
• D. A school-age child with acute glomerulonephritis and brown-colored urine

Correct answer: A

Rationale: The nurse should assess the toddler with a concussion and an episode of forceful vomiting first when receiving change-of-shift report for children. Forceful vomiting in a toddler with a concussion indicates increased intracranial pressure, requiring immediate assessment and intervention to prevent further complications.

5. A 9-month-old infant who is not sitting independently has been diagnosed with ataxic cerebral palsy (CP). Which clinical manifestations would the nurse expect to see in the baby?

• A. Hypotonia and muscle instability
• B. Hypertonia and persistence of primitive reflexes
• C. Tremors and exaggerated posturing
• D. Hemiplegia and hypertonia

Correct answer: A

Rationale: In ataxic cerebral palsy, the characteristic features include hypotonia (low muscle tone) and muscle instability. These manifestations contribute to the infant's difficulty in achieving independent sitting. Hypertonia (increased muscle tone) and persistence of primitive reflexes, as mentioned in option B, are more commonly associated with other types of cerebral palsy like spastic CP. Tremors and exaggerated posturing (option C) are not typical features of ataxic CP. Hemiplegia (paralysis of one side of the body) and hypertonia (increased muscle tone) mentioned in option D are more commonly seen in other types of cerebral palsy, such as spastic CP.

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