Nursing Elites

1. While eating in the hospital cafeteria, a nurse notices a toddler at a nearby table choking on a piece of food and appearing slightly blue. What is the appropriate initial action to take?

• A. Begin mouth-to-mouth resuscitation
• B. Give the child water to help with swallowing
• C. Perform 5 abdominal thrusts
• D. Call for the emergency response team

Correct answer: C

Rationale: When a toddler is choking on a piece of food and appears blue, it indicates airway obstruction. The appropriate initial action should be to perform 5 abdominal thrusts. This technique can help dislodge the obstructing object and clear the airway. Initiating mouth-to-mouth resuscitation is not recommended as the first step in a choking emergency, especially in children. Giving water may not be effective and can worsen the situation by causing further blockage. Calling the emergency response team should be considered if the abdominal thrusts are unsuccessful in clearing the airway.

2. When assessing a patient who has just arrived after an automobile accident, the emergency department nurse notes tachycardia and absent breath sounds over the right lung. For which intervention will the nurse prepare the patient?

• A. Emergency pericardiocentesis
• B. Stabilization of the chest wall with tape
• C. Administration of an inhaled bronchodilator
• D. Insertion of a chest tube with a chest drainage system

Correct answer: D

Rationale: The patient's history and absent breath sounds suggest a right-sided pneumothorax or hemothorax, which will require treatment with a chest tube and drainage. Emergency pericardiocentesis is not indicated as the patient's symptoms are not suggestive of cardiac tamponade. Stabilization of the chest wall with tape would not address the underlying issue of a potential pneumothorax or hemothorax. Administration of an inhaled bronchodilator is not appropriate in this scenario as the patient is not exhibiting signs of asthma or bronchoconstriction. Therefore, the correct intervention for this patient is the insertion of a chest tube with a chest drainage system to address the potential pneumothorax or hemothorax.

3. A child is diagnosed with Hirschsprung's disease. The nurse is teaching the parents about the cause of the disease. Which statement, if made by the parent, supports that teaching was successful?

• A. The absence of special cells in the rectum caused the disease.
• B. Incomplete digestion of the protein part of wheat, barley, rye, and oats is not the cause of the disease.
• C. The disease does not occur due to increased bowel motility leading to spasm and pain.
• D. The disease is not caused by the inability to tolerate sugar found in dairy products.

Correct answer: A

Rationale: Hirschsprung's disease, also known as congenital aganglionosis or megacolon, is characterized by the absence of ganglion cells in the rectum and, sometimes, extending into the colon. Choice A correctly explains the cause of Hirschsprung's disease. Choice B is incorrect as it describes celiac disease, which is related to gluten intolerance. Choice C is inaccurate as it describes symptoms of irritable bowel syndrome, not the cause of Hirschsprung's disease. Choice D is wrong as it pertains to lactose intolerance, not Hirschsprung's disease.

4. A 3-year-old child is seen in the health care clinic, and a diagnosis of encopresis is made. The nurse expects to provide teaching about which client problem?

• A. Odor
• B. Nausea
• C. Malaise
• D. Diarrhea

Correct answer: A

Rationale: Encopresis is the repeated voluntary or involuntary passage of feces of normal or near-normal consistency in places not appropriate for that purpose according to the individual's own sociocultural setting. Signs of encopresis include evidence of soiled clothing, scratching or rubbing the anal area due to irritation, fecal odor without apparent awareness by the child, and social withdrawal. Teaching about odor is essential to address the issue of encopresis. Choices B, C, and D are incorrect because encopresis is not typically associated with nausea, malaise, or diarrhea. Therefore, teaching about these symptoms would not be relevant in the context of encopresis.

5. A patient with a cast on the right leg is being cared for by a nurse. Which of the following assessment findings would be most concerning for the nurse?

• A. The capillary refill time is 2 seconds
• B. The patient complains of itching and discomfort
• C. The cast has a foul-smelling odor
• D. The patient is on antibiotics

Correct answer: C

Rationale: A foul-smelling odor emanating from the cast is a concerning finding as it indicates the possibility of infection or the presence of a pressure ulcer. These conditions can lead to serious complications if not promptly addressed. It is crucial for the nurse to investigate further and take appropriate actions to prevent potential harm to the patient. The other options do not directly indicate a risk of infection or complications associated with the cast. Itching and discomfort are common complaints due to wearing a cast, and the patient being on antibiotics may be part of their treatment plan for an unrelated condition. Capillary refill time of 2 seconds is within the normal range and would not be a cause for immediate concern in this scenario.

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