Nursing Elites

1. A nurse is planning care for a school-age child who has thrombocytopenia. Which of the following interventions should the nurse include in the plan?

• A. Administer aspirin as needed for fever.
• B. Avoid venipunctures whenever possible.
• C. Encourage the child to participate in contact sports.
• D. Administer ibuprofen for pain.

Correct answer: B

Rationale: The correct answer is B: 'Avoid venipunctures whenever possible.' Thrombocytopenia is a condition characterized by a low platelet count, which can lead to an increased risk of bleeding. Venipunctures can cause bleeding in these patients; therefore, they should be avoided whenever possible. Choice A is incorrect because aspirin should be avoided in patients with thrombocytopenia as it can further increase the risk of bleeding due to its antiplatelet effects. Choice C is incorrect because participating in contact sports can also increase the risk of injury and bleeding in a child with thrombocytopenia. Choice D is incorrect as ibuprofen, like aspirin, can also increase the risk of bleeding and should be avoided in these patients.

2. During an assessment, an infant is suspected to have intussusception. Which of the following findings should the nurse expect?

• A. Currant jelly stools
• B. Projectile vomiting
• C. Scaphoid abdomen
• D. Frequent stools

Correct answer: A

Rationale: Intussusception is a condition where one segment of the intestine telescopes into another, causing obstruction. The classic presentation includes currant jelly stools, which are a mixture of blood and mucus due to the sloughing of the intestinal mucosa. This finding is a result of the compromised blood supply to the affected area and is a key characteristic associated with intussusception.

3. A nurse is providing discharge teaching to the parent of a school-age child who has moderate persistent asthma. Which of the following instructions should the nurse include?

• A. You should give your child his salmeterol inhaler every 4 hours when he is having an acute episode of wheezing.
• B. You should monitor your child's weight weekly while he is receiving inhaled corticosteroid therapy.
• C. Pulmonary function tests will be performed every 12 to 24 months to evaluate how your child is responding to therapy.
• D. When using the peak expiratory flow meter, record your child's average of three readings.

Correct answer: C

Rationale: The nurse should inform the parent that the child will need pulmonary function tests every 12 to 24 months to assess lung function and response to treatment. These tests help evaluate the presence of lung disease, monitor disease progression, and assess the effectiveness of the current therapeutic regimen in managing asthma. Choice A is incorrect as salmeterol is not used for acute wheezing episodes but rather for long-term maintenance. Choice B is incorrect because weight monitoring is not directly related to inhaled corticosteroid therapy for asthma. Choice D is incorrect as peak expiratory flow meter readings should be recorded as instructed, not averaged.

4. 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.

5. The nurse provides discharge instructions to a patient prescribed verapamil SR 120mg PO daily for HTN. Which statement by the patient indicates understanding of the medication?

• A. �I will take the medication with grapefruit juice each morning.�
• B. �I should expect occasional loose stools from this medication�
• C. �I�ll need to reduce the amount of fiber in my diet�
• D. �I must swallow the pill whole.�

Correct answer: D

Rationale: �SR� indicates that the drug is sustained release; therefore, the patient must swallow the pill intact, without chewing or crushing, which would result in a bolus effect. Grapefruit juice should be avoided, because it can inhibit intestinal and hepatic metabolism of the drug, thereby raising the drug level. Constipation, not loose stools, is a common side effect. Increasing fluids and dietary fiber can help prevent this adverse effect.

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