Nursing Elites

1. A nurse prepares to care for a 4-year-old newly admitted for rhabdomyosarcoma. The nurse should alert the staff to pay more attention to the function of which area of the body?

• A. All striated muscles
• B. The cerebellum
• C. The kidneys
• D. The leg bones

Correct answer: A

Rationale: Rhabdomyosarcoma is the most common soft tissue sarcoma in children, originating in striated (skeletal) muscles and potentially affecting any part of the body. Symptoms vary based on the location of the tumor. In the head or neck area, symptoms may include sudden bulging or swelling of the eyes, conjunctival chemosis, and headache. Rhabdomyosarcoma can also impact organs like the urinary or reproductive system. Common metastatic sites include the lungs. Therefore, the nurse should pay attention to the function of all striated muscles in the child to monitor for any signs or symptoms related to the disease. Choices B, C, and D are incorrect as rhabdomyosarcoma primarily involves striated muscles and does not specifically target the cerebellum, kidneys, or leg bones.

2. A nurse is assessing a client who is post-op day #3 after an abdominal hernia repair. After a bout of harsh coughing, the client states, 'it feels like something gave way.' The nurse assesses his abdomen and notes an evisceration from the surgical site. What is the next action of the nurse?

• A. Turn the client on his side
• B. Push the abdominal contents back inside the wound using sterile gloves
• C. Ask the client to take a breath and hold it
• D. Cover the intestine with sterile saline dressings

Correct answer: D

Rationale: A wound evisceration occurs when the edges of an abdominal wound separate, allowing the coils of the intestine to protrude outside of the body. The nurse should notify the physician at once if this occurs. While waiting for treatment, the nurse should cover the intestines with sterile gauze soaked in saline. Turning the client on his side or asking the client to take a breath and hold it are not appropriate actions in this situation. Pushing the abdominal contents back inside the wound using sterile gloves can lead to infection and is not within the nurse's scope of practice.

3. The child with hemolytic-uremic syndrome is anuric and will undergo peritoneal dialysis. Which measure should the nurse implement?

• A. Restrict fluids as prescribed.
• B. Care for the arteriovenous fistula.
• C. Encourage foods high in potassium.
• D. Administer analgesics as prescribed.

Correct answer: A

Rationale: In hemolytic-uremic syndrome, often associated with bacterial toxins and viruses, acute kidney injury occurs in children, leading to symptoms like anemia, thrombocytopenia, renal injury, and CNS symptoms. For an anuric child with hemolytic-uremic syndrome undergoing peritoneal dialysis, fluid restriction is vital to prevent fluid overload. Pain management is not directly related to hemolytic-uremic syndrome. Foods high in potassium should be limited, not encouraged, due to impaired kidney function. Peritoneal dialysis does not involve an arteriovenous fistula, which is specific to hemodialysis.

4. A patient is being treated in the Neurology Unit for Meningitis. Which of these is a priority assessment for the nurse to make?

• A. Assess the patient for nuchal rigidity
• B. Determine the patient's past exposure to infectious organisms
• C. Check the patient's WBC lab values
• D. Monitor for increased lethargy and drowsiness

Correct answer: D

Rationale: Monitoring for increased lethargy and drowsiness is crucial as these symptoms indicate a decreased level of consciousness, which is the cardinal sign of increased Intracranial Pressure (ICP). Elevated ICP can lead to serious complications and requires immediate intervention. Assessing for nuchal rigidity is important in suspected cases of meningitis but monitoring lethargy and drowsiness takes precedence due to its direct correlation with ICP. Determining past exposure to infectious organisms and checking WBC lab values are important for diagnosing and treating meningitis but do not directly address the immediate concern of increased ICP.

5. A patient with right lower-lobe pneumonia has been treated with IV antibiotics for 3 days. Which assessment data obtained by the nurse indicates that the treatment has been effective?

• A. Bronchial breath sounds are heard at the right base.
• B. The patient coughs up small amounts of green mucus.
• C. The patients white blood cell (WBC) count is 9000/L
• D. Increased tactile fremitus is palpable over the right chest

Correct answer: C

Rationale: The normal WBC count indicates that the antibiotics have been effective. All the other data suggest that a change in treatment is needed.

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