Nursing Elites

1. A parent of a school-age child is receiving discharge teaching following a cardiac catheterization. Which of the following instructions should be included by the nurse?

• A. Allow the child to bathe 6 hours after the procedure.
• B. Keep the child on bed rest for 12 hours.
• C. Maintain a pressure dressing on the site for 8 hours.
• D. Resume regular activities the day after the procedure.

Correct answer: B

Rationale: The correct instruction that the nurse should include is to keep the child on bed rest for 12 hours following a cardiac catheterization. This is important to prevent bleeding at the insertion site and ensure proper healing. Allowing the child to bathe soon after the procedure, maintaining a pressure dressing for only 8 hours, or resuming regular activities the day after the procedure can increase the risk of complications such as bleeding or infection.

2. What does a Z-score of -3.00 indicate?

• A. The child's score indicates he is ahead of his peers and performing well
• B. The child's score places him within normal limits on this test item
• C. The test is inconclusive
• D. The child's score falls below the majority of his peers on this test

Correct answer: D

Rationale: A Z-score of -3.00 indicates that the child's performance is significantly below the average of their peers. It represents an extreme low score, indicating a substantial deviation from the mean performance of the group.

3. A parent of a child with oral candidiasis is being taught by a nurse. Which statement by the parent indicates an understanding of the teaching?

• A. I will boil the nipples and pacifiers for 20 minutes each day.
• B. I will stop the medication as soon as the spots disappear.
• C. I will apply an over-the-counter steroid cream to the spots.
• D. I will mix the medication in my child's bottle.

Correct answer: A

Rationale: Boiling the nipples and pacifiers for 20 minutes each day is an appropriate measure to prevent reinfection of oral candidiasis. This practice helps eliminate the Candida fungus from these items, reducing the risk of the child getting reinfected. It is crucial for the parent to follow this hygienic practice consistently to ensure the child's recovery and prevent the spread of the infection.

4. A patient in the emergency department reports taking sildenafil (Viagra) and nitroglycerin 1 hr before sexual activity. Which finding should the nurse immediately report to the physician?

• A. WBC of 3200 cells/mm³
• B. RR of 26 breaths/min
• C. Temp of 38°C
• D. BP of 70/50

Correct answer: D

Rationale: The correct answer is D: BP of 70/50. When sildenafil (Viagra) is taken with nitroglycerin, it can cause severe hypotension that is unresponsive to treatment. The combination of these medications can lead to a dangerous drop in blood pressure. It is crucial to immediately report hypotension in this scenario as it poses a significant risk to the patient's life. It is recommended to allow at least 24 hours to elapse between the last dose of sildenafil and nitroglycerin to prevent such adverse effects. The other vital signs and lab values may be abnormal but do not have the immediate life-threatening implications that severe hypotension does in this context.

5. A child is being cared for following a head injury. Which of the following findings should indicate to the healthcare provider that the child is developing diabetes insipidus?

• A. Urine specific gravity of 1.045
• B. Sodium level of 155
• C. Blood glucose level of 45
• D. Urine output of 35 ml per hour

Correct answer: B

Rationale: In a child with a head injury, the development of diabetes insipidus can occur due to pituitary hypofunction, leading to a deficiency of antidiuretic hormone. An elevated sodium level (hypernatremia) is a key finding in diabetes insipidus due to the excessive loss of free water in the urine, resulting in increased sodium concentration in the blood.

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