Nursing Elites

1. When a patient is taking glucocorticoids and digoxin, which electrolyte should the nurse prioritize monitoring?

• A. Calcium
• B. Magnesium
• C. Sodium
• D. Potassium

Correct answer: D

Rationale: The nurse should primarily monitor potassium levels in a patient taking glucocorticoids and digoxin. Glucocorticoids can lead to potassium loss, potentially increasing the risk of digoxin toxicity. Additionally, glucocorticoids may worsen hypokalemia induced by diuretics like thiazides and loops. While calcium, magnesium, and sodium are important electrolytes to monitor in various clinical situations, they are not the priority in this specific scenario of a patient on glucocorticoids and digoxin.

2. A 6-year-old child with daytime enuresis complains of dysuria and urgency. What does the nurse recognize these signs and symptoms indicate?

• A. Urinary tract infection
• B. Nephrotic syndrome
• C. Acute glomerulonephritis
• D. Vesicoureteral reflux

Correct answer: A

Rationale: The signs and symptoms of dysuria and urgency in a child with daytime enuresis typically indicate a urinary tract infection (UTI). These symptoms, along with urinary frequency and pain during urination, are common manifestations of a UTI in children. Nephrotic syndrome is characterized by edema, proteinuria, hypoalbuminemia, and hyperlipidemia, rather than dysuria and urgency. Acute glomerulonephritis presents with hematuria, proteinuria, hypertension, and oliguria, not dysuria and urgency. Vesicoureteral reflux can lead to recurrent UTIs but does not directly cause dysuria and urgency.

3. A 4-year-old child is admitted to the hospital secondary to dehydration. Laboratory tests indicate a high hemoglobin and hematocrit, and the serum sodium is below normal levels. Which condition does the nurse suspect based on the current data?

• A. Hypernatremia
• B. Metabolic acidosis
• C. Hypotonic dehydration
• D. Isotonic dehydration

Correct answer: C

Rationale: The correct answer is hypotonic dehydration. The combination of high hemoglobin and hematocrit with low serum sodium indicates hypotonic dehydration. In this condition, there is an excess of solutes relative to water, leading to higher red blood cell concentration (elevated hemoglobin and hematocrit) and low serum sodium levels.

4. Which statement should the nurse include in the teaching plan for a patient being started on levodopa/carbidopa (Sinemet) for newly diagnosed Parkinson’s disease?

• A. Take medication on a full stomach
• B. Change positions slowly
• C. The drug may cause the urine to be very dilute
• D. Carbidopa has many adverse effects

Correct answer: B

Rationale: Postural hypotension is common early in treatment, so the patient should be instructed to change positions slowly. Administration with meals should be avoided, if possible, because food delays the absorption of the levodopa component. If the patient is experiencing side effects of nausea and vomiting, administration with food may be considered. The levodopa component may darken urine. Carbidopa has no adverse effects of its own.

5. Mary is excited to work with the family of a friend with whom she has lost contact. Mary hopes the family will be able to connect her with her friend and is looking forward to hearing about her friend. At the next session, she asks the mother many questions about her friend and they spend a lot of time discussing their home town, etc. Which statement describes this scenario?

• A. It is not therapeutic: The relationship serves no purpose
• B. It is therapeutic: Therapist, child, and family have a reciprocal caring relationship
• C. It is not therapeutic: Mary is benefiting, but not the child and family
• D. It is therapeutic: Both parties are benefiting in the relationship

Correct answer: C

Rationale: In this scenario, Mary's focus on her own needs and interests by asking the mother about her lost friend and hometown indicates a lack of therapeutic benefit for the child and family. Effective therapy should prioritize the needs and goals of the child and family, not the therapist's personal desires or connections. Therefore, this interaction is not therapeutic as it fails to address the primary purpose of the therapy, which is to benefit the child and family. Choice A is incorrect because while the relationship may not be therapeutic, it does serve a purpose for Mary. Choice B is incorrect as there is no indication of a reciprocal caring relationship in this scenario. Choice D is incorrect as the focus is primarily on Mary's personal interests, rather than mutual benefit in the therapeutic relationship.

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