Nursing Elites

1. A client has a new diagnosis of celiac disease. Which of the following clinical manifestations should the nurse expect?

• A. Steatorrhea
• B. Projectile vomiting
• C. Sunken abdomen
• D. Weight gain

Correct answer: A

Rationale: Celiac disease is a condition where individuals are unable to digest gluten, leading to damage in the bowel cells and subsequent malabsorption. This malabsorption commonly presents with symptoms such as steatorrhea, which is characterized by foul-smelling, greasy, and bulky stools due to high fat content. Projectile vomiting and sunken abdomen are not typical manifestations of celiac disease. Weight gain is unlikely in individuals with celiac disease due to malabsorption and nutrient deficiencies. Therefore, the nurse should expect steatorrhea as a clinical manifestation in clients with celiac disease.

2. A patient with Parkinson�s disease who takes levodopa/carbidopa (Sinemet) comes to the clinic for a semi-annual physical examination. Which question is the most important for that nurse to ask?

• A. Have you noticed any swelling in your feet?
• B. Are you having vivid dreams or hallucination?
• C. Have you noticed any changes in your stool?
• D. Have you had your flu vaccine?

Correct answer: B

Rationale: Patients taking levodopa/carbidopa (Sinemet) are at increased risk for the psychiatric side effects of levodopa, including visual hallucinations, vivid dreams, nightmares, and paranoid ideation. The other questions are not directly related to problems that are likely to occur with this drug.

3. What is an appropriate intervention for the edematous child with reduced mobility related to nephrotic syndrome?

• A. Assist the child in minimizing body movements.
• B. Change the child's position frequently.
• C. Maintain the child's bed flat.
• D. Keep edematous areas moist and covered.

Correct answer: B

Rationale: Changing the child's position frequently is essential for preventing respiratory tract infections and reducing pressure on delicate skin, which are common risks for edematous children with reduced mobility due to nephrotic syndrome. This intervention helps promote circulation and prevents complications associated with prolonged immobility.

4. Which physical assessment technique should be omitted when caring for a 2-year-old child diagnosed with Wilms' tumor?

• A. Performing range-of-motion exercises on lower extremities
• B. Palpating the abdomen
• C. Assessing for bowel sounds
• D. Percussing ankle and knee reflexes

Correct answer: B

Rationale: Palpating the abdomen should be omitted when caring for a 2-year-old child diagnosed with Wilms' tumor because it could disturb the tumor and potentially cause the malignancy to spread. The other assessment techniques are safe to perform and provide valuable information about the child's condition. Range-of-motion exercises help assess mobility and joint health, assessing for bowel sounds is important to monitor gastrointestinal function, and percussing ankle and knee reflexes can help evaluate neurological responses.

5. Which statement made by a parent of a child with nephrotic syndrome indicates an understanding of discharge teaching?

• A. I will make sure he gets his measles vaccine as soon as he gets home.
• B. He can stop taking his medication next week.
• C. I should check his urine for protein when he goes to the bathroom.
• D. He should eat a low-protein diet for the next few weeks.

Correct answer: C

Rationale: In nephrotic syndrome, monitoring urine for protein is essential as it helps track the child's condition. Checking urine for protein should be done as part of the discharge teaching to keep a record of the child's urinary proteins and to monitor the effectiveness of the treatment plan. It is crucial for parents to understand this aspect of care to ensure proper management of the child's condition. Choices A, B, and D are incorrect because getting a measles vaccine, stopping medication prematurely, and following a low-protein diet are not directly related to monitoring the child's condition and managing nephrotic syndrome.

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