Nursing Elites

1. A patient is prescribed fluconazole (Diflucan) for a vaginal yeast infection. The nurse should be concerned if the patient is also taking which medication?

• A. Losartan (Cozaar)
• B. Simvastatin (Zocor)
• C. Lisinopril (Zestril)
• D. Hydrochlorothiazide (HCTZ)

Correct answer: B

Rationale: When fluconazole is taken with statins like simvastatin, it can increase the levels of the statin in the blood, potentially leading to adverse effects such as muscle pain and weakness. Therefore, the nurse should be concerned if the patient is taking simvastatin along with fluconazole.

2. Which physical assessment technique should be omitted when caring for a 2-year-old child diagnosed with Wilms' tumor?

• A. Performing range-of-motion exercises on lower extremities
• B. Palpating the abdomen
• C. Assessing for bowel sounds
• D. Percussing ankle and knee reflexes

Correct answer: B

Rationale: Palpating the abdomen should be omitted when caring for a 2-year-old child diagnosed with Wilms' tumor because it could disturb the tumor and potentially cause the malignancy to spread. The other assessment techniques are safe to perform and provide valuable information about the child's condition. Range-of-motion exercises help assess mobility and joint health, assessing for bowel sounds is important to monitor gastrointestinal function, and percussing ankle and knee reflexes can help evaluate neurological responses.

3. Which assessment finding for a 4-month-old infant would require further action by the nurse?

• A. The posterior fontanel is open.
• B. The infant has good head control when held upright.
• C. The infant is able to roll only from abdomen to back.
• D. The anterior fontanel is open and soft.

Correct answer: A

Rationale: The correct answer is A. The posterior fontanel should be closed by 4 months of age. An open posterior fontanel at this age may indicate a delay in normal closure, which could be a cause for concern and require further evaluation by the healthcare provider to ensure proper development and growth. Choices B, C, and D are typical developmental milestones for a 4-month-old infant and do not raise immediate concerns requiring further action by the nurse.

4. A toddler in the emergency department has partial thickness burns on his right arm. Which of the following actions should the nurse take?

• A. Insert a nasogastric tube
• B. Initiate prophylactic antibiotic therapy
• C. Cleanse the affected area with mild soap and water
• D. Apply a topical corticosteroid to the affected area

Correct answer: C

Rationale: When a toddler has partial thickness burns, the nurse should cleanse the affected area with mild soap and water. This action helps remove any loose tissue that could lead to infection and prepares the area for appropriate wound care. Inserting a nasogastric tube (Choice A) is not indicated for a toddler with burns. Initiating prophylactic antibiotic therapy (Choice B) is not necessary for partial thickness burns unless there are signs of infection. Applying a topical corticosteroid (Choice D) is not recommended for initial management of burns as it can delay wound healing.

5. In the morning, a healthcare professional receives change-of-shift report on four pediatric clients, each of whom has some form of fluid-volume excess. Which of the children should the healthcare professional see first?

• A. The child with tachypnea and pulmonary congestion
• B. The child with hepatomegaly and normal respiratory rate
• C. The child with dependent and sacral edema and regular pulse
• D. The child with periorbital edema and normal respiratory rate

Correct answer: A

Rationale: The child with tachypnea and pulmonary congestion should be seen first. Tachypnea indicates an increased respiratory rate, a sign of possible respiratory distress. Pulmonary congestion suggests fluid accumulation in the lungs, posing a serious risk to respiratory function. Immediate attention is crucial in this case. Choice B is incorrect as hepatomegaly alone does not indicate an acute issue requiring immediate attention. Choices C and D, while showing signs of fluid-volume excess, do not present the same level of respiratory compromise as tachypnea and pulmonary congestion, making them lower priority.

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