Nursing Elites

1. A healthcare provider is assessing vital signs in pediatric patients. Which of the following vital signs is abnormal?

• A. 11-year-old male: 90 BPM, 22 RPM, 100/70 mmHg
• B. 13-year-old female: 105 BPM, 22 RPM, 105/50 mmHg
• C. 5-year-old male: 102 BPM, 24 RPM, 90/65 mmHg
• D. 6-year-old female: 100 BPM, 26 RPM, 90/70 mmHg

Correct answer: B

Rationale: The normal range of vital signs for pediatric patients varies with age. For 11 to 14-year-olds, the normal vital sign ranges are: Heart rate: 60-105 BPM; Respiratory rate: 12-20 RPM; Blood pressure: Systolic 85-120 mmHg, Diastolic 55-80 mmHg. The 13-year-old female in choice B has a diastolic blood pressure below the normal range, indicating hypotension. Additionally, her heart rate is at the upper limit of normal, and her respiratory rate is within normal limits. Choices A, C, and D all fall within the normal ranges for vital signs in pediatric patients.

2. A client with myocardial infarction is receiving tissue plasminogen activator, alteplase (Activase, tPA). While on the therapy, the nurse plans to prioritize which of the following?

• A. Observe for neurological changes
• B. Monitor for any signs of renal failure
• C. Check the food diary
• D. Observe for signs of bleeding

Correct answer: D

Rationale: The priority concern for a client receiving thrombolytic medication, such as tissue plasminogen activator (alteplase), is to monitor for signs of bleeding. Thrombolytics work by converting plasminogen to plasmin, which degrades fibrin. This process can lead to the breakdown of both fibrin-bound plasminogen on thrombi surfaces and unbound plasminogen in the plasma. The resulting plasmin can degrade fibrin, fibrinogen, factor V, and factor VIII. Observing for signs of bleeding is crucial due to the increased risk of hemorrhage associated with thrombolytic therapy. Monitoring for neurological changes, signs of renal failure, or checking the food diary are not the immediate priorities compared to detecting and managing potential bleeding complications.

3. Application - The nurse is caring for a patient who has the following labs: Creatinine 2.5mg/dL, WBC 11,000 cells/mL, and Hemoglobin of 12 g/dL. Based on this information, which of these orders would the nurse question?

• A. Administer 30 Units of Lantus Daily
• B. CT of the spine with contrast
• C. X-ray of the abdomen and chest
• D. Administer heparin subcutaneously 5,000 Units every 12 hours

Correct answer: B

Rationale: The correct answer is to question the order for a CT of the spine with contrast. The patient's elevated creatinine level of 2.5mg/dL indicates impaired kidney function. Contrast agents are nephrotoxic and can further compromise kidney function in patients with existing nephropathy. Therefore, it is crucial to avoid contrast-enhanced imaging studies in patients with impaired renal function. Choice A: Administering 30 Units of Lantus Daily is not contraindicated based on the provided lab values. Choice C: Ordering an X-ray of the abdomen and chest is not contraindicated based on the provided lab values. Choice D: Administering heparin subcutaneously at 5,000 Units every 12 hours is not contraindicated based on the provided lab values.

4. While caring for a patient with respiratory disease, the nurse observes that the patient's SpO2 drops from 93% to 88% while the patient is ambulating in the hallway. What is the priority action of the nurse?

• A. Notify the healthcare provider
• B. Document the response to exercise
• C. Administer the PRN supplemental O2
• D. Encourage the patient to pace activity

Correct answer: C

Rationale: The drop in SpO2 to 88% indicates that the patient is hypoxemic and needs supplemental oxygen when exercising. Administering PRN supplemental oxygen is the priority action to correct the hypoxemia and ensure adequate oxygenation during activity. Notifying the healthcare provider can be done after stabilizing the patient's oxygen levels. Documenting the response to exercise is important but secondary to addressing the immediate hypoxemia. Encouraging the patient to pace activity is not sufficient to address the acute drop in SpO2 and provide the necessary oxygen support.

5. A client is seen for testing to rule out Rocky Mountain Spotted Fever. Which of the following signs or symptoms is associated with this condition?

• A. Fever and rash
• B. Circumoral cyanosis
• C. Elevated glucose levels
• D. All of the above

Correct answer: A

Rationale: The correct answer is 'Fever and rash.' Rocky Mountain Spotted Fever (RMSP) is caused by the R. rickettsii pathogen, which damages blood vessels. Patients with RMSP typically present with fever, edema, and a rash that initially appears on the hands and feet before spreading across the body. The disease manifests following a tick bite. Choice A is correct as fever and rash are key indicators of RMSP. Circumoral cyanosis (choice B) is not typically associated with RMSP; it refers to a bluish discoloration around the mouth and is more indicative of oxygen deprivation. Elevated glucose levels (choice C) are not specific signs of RMSP. Therefore, choice D, 'All of the above,' is incorrect since only choice A, 'Fever and rash,' is associated with Rocky Mountain Spotted Fever.

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