Nursing Elites

1. A nurse working in a pediatric clinic observes bruises on the body of a four-year-old boy. The parents report the boy fell while riding his bike. The bruises are located on his posterior chest wall and gluteal region. What should the nurse do?

• A. Suggest a script for counseling the family to the doctor on duty.
• B. Recommend a warm bath for the boy to decrease healing time.
• C. Notify the case manager in the clinic about possible child abuse concerns.
• D. Recommend ROM exercises to the patient's spine to decrease healing time.

Correct answer: C

Rationale: In this scenario, the nurse is observing bruises on a child's body that are located in areas not commonly associated with accidental injuries. Given the concerning nature of the bruising pattern and the inconsistent history provided by the parents, the nurse should suspect possible child abuse and take appropriate action by notifying the case manager in the clinic. The safety and well-being of the child should always be the top priority. Counseling for the family, warm baths, or recommending range of motion (ROM) exercises are not appropriate actions in this situation and may not address the underlying issue of potential child abuse.

2. Which of the following medications is a serotonin antagonist that might be used to relieve nausea and vomiting?

• A. metoclopramide (Reglan)
• B. ondansetron (Zofran)
• C. hydroxyzine (Vistaril)
• D. prochlorperazine (Compazine)

Correct answer: B

Rationale: Zofran is a serotonin antagonist commonly used to relieve nausea and vomiting by blocking serotonin receptors. Metoclopramide (Reglan) acts on dopamine receptors, hydroxyzine (Vistaril) is an antihistamine, and prochlorperazine (Compazine) is a dopamine antagonist. While these medications can also be used for nausea and vomiting, they do not primarily function as serotonin antagonists like ondansetron.

3. The client asked about the role of leptin in the body. Which response should the nurse provide?

• A. It increases food intake in clients, thereby promoting obesity.
• B. It assists in the regulation of steroids.
• C. It increases the total fat mass of people who are obese.
• D. It might decrease the total fat mass in the bodies of people who are obese.

Correct answer: D

Rationale: Leptin is a protein hormone expressed in fat cells that regulates fat cell percentage in the body. It is associated with increased energy expenditure and decreased food intake through hypothalamic control. In obese individuals, there may be insensitivity or resistance to leptin's effects. Leptin influences other hormones like insulin and genetic factors related to fat regulation. Therefore, the correct response is that leptin might decrease total fat mass in obese individuals as it is involved in energy balance and fat regulation. Choices A, B, and C are incorrect because leptin does not increase food intake or promote obesity; it does not assist in the regulation of steroids, and it does not increase total fat mass in people who are obese.

4. The nurse is preparing for a dressing change on a full thickness burn to the flank area. The orders include irrigating the wound with each dressing change. To irrigate the wound, what will the nurse use?

• A. Sterile saline
• B. Distilled water
• C. Betadine scrub
• D. Tap water

Correct answer: A

Rationale: When irrigating a wound, especially in the case of a full-thickness burn, it is crucial to use a solution that is gentle and non-irritating to the tissues. Sterile saline is the preferred choice for wound irrigation as it is isotonic and does not cause additional damage to the already compromised tissue. Distilled water lacks the electrolytes present in saline, Betadine scrub is not used for irrigation due to its potential to be cytotoxic, and tap water may introduce contaminants and microorganisms to the wound.

5. The nurse is caring for a client complaining of intense headaches with increasing pain for the past one month. An MRI is ordered. In reviewing the client's information, which piece of information is of concern?

• A. Allergy to shellfish
• B. Has a cardiac pacemaker
• C. A diabetic
• D. No IV access

Correct answer: B

Rationale: The correct answer is 'Has a cardiac pacemaker.' If a client with a cardiac pacemaker undergoes an MRI, the magnetic field can interfere with the pacemaker's function, leading to serious complications or even death. It is crucial to ensure that the pacemaker is compatible with MRI imaging or to consider alternative imaging modalities. The other choices, such as 'Allergy to shellfish,' 'A diabetic,' and 'No IV access,' are not direct contraindications for an MRI scan and do not pose the same level of risk as having a cardiac pacemaker.

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