Nursing Elites

1. A young child admitted to the pediatric unit has fever, irritability, and vomiting with suspected bacterial meningitis. Which cerebrospinal fluid (CSF) result should the nurse anticipate based on these data?

• A. Decreased protein count
• B. Clear, straw-colored fluid
• C. Positive for red blood cells (RBCs)
• D. Decreased glucose level

Correct answer: D

Rationale: In bacterial meningitis, the glucose level in the cerebrospinal fluid (CSF) is typically decreased due to the increased utilization of glucose by the infecting bacteria. This metabolic change leads to a decrease in CSF glucose levels, making choice D the correct answer in this scenario. Choices A, B, and C are incorrect because bacterial meningitis usually results in an increased protein count, cloudy appearance of the CSF due to the presence of bacteria, and absence of red blood cells (RBCs) in the CSF unless there is a traumatic tap, respectively.

2. 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.

3. The mother of a 5-year-old child taking prednisone for nephrotic syndrome tells the nurse he needs to get immunizations to enter kindergarten. What does the nurse clarify about receiving immunizations while on prednisone?

• A. Can interfere with the treatment for nephrosis.
• B. Require that the child have antibiotic coverage.
• C. Can be given in smaller, divided doses.
• D. Should be delayed.

Correct answer: D

Rationale: No vaccinations or immunizations should be administered while the disease is active and during immunosuppressive therapy.

4. A healthcare provider at an urgent care clinic is assessing an adolescent client who has an upper respiratory tract infection. Which of the following findings should the provider recognize as a manifestation of pertussis?

• A. Inflamed throat with exudate
• B. Purulent eye drainage
• C. Dry, hacking cough
• D. Koplik spots on buccal mucosa

Correct answer: C

Rationale: The correct answer is C: 'Dry, hacking cough.' A dry, hacking cough is a classic manifestation of pertussis. Pertussis typically presents with symptoms of an upper respiratory tract infection, starting with a persistent, severe, and uncontrollable cough that can worsen at night. This cough is often followed by a high-pitched 'whoop' sound as the patient tries to catch their breath, hence the term 'whooping cough.' In contrast, options A, B, and D are not typically associated with pertussis. Inflamed throat with exudate may suggest a bacterial throat infection like streptococcal pharyngitis, purulent eye drainage is more indicative of a bacterial conjunctivitis, and Koplik spots on the buccal mucosa are specific to measles. Therefore, recognizing the dry, hacking cough as a manifestation of pertussis is crucial for early identification and appropriate management of the disease.

5. A healthcare professional is performing hearing screenings for children at a community health fair. Which of the following children should the professional refer to a provider for a more extensive hearing evaluation?

• A. A toddler who is 18 months old and has unintelligible speech
• B. An infant who is 3 months old and has an exaggerated startle response
• C. A preschooler who is 4 years old and prefers playing with others rather than alone
• D. An infant who is 8 months old and is not yet making babbling sounds

Correct answer: D

Rationale: The healthcare professional should refer an infant who is not making babbling sounds by the age of 7 months to a provider for a more extensive evaluation of hearing. Babbling sounds are a developmental milestone that typically occurs by 7 months of age. Delayed or absent babbling can indicate potential hearing issues that warrant further assessment.

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