Nursing Elites

1. An emergency department nurse is performing an assessment on a child with a suspected diagnosis of intussusception. Which assessment question for the parents will elicit the most specific data related to this disorder?

• A. Does the child have any food allergies?
• B. What do the bowel movements look like?
• C. Has the child eaten any food in the last 24 hours?
• D. Can you describe the type of pain that the child is experiencing?

Correct answer: D

Rationale: The correct answer is asking the parents to describe the type of pain the child is experiencing because a report of severe colicky abdominal pain in a healthy, thriving child between 3 and 17 months of age is the classic presentation of intussusception. Typical behavior includes screaming and drawing the knees up to the chest. This specific question helps in identifying the key symptom of intussusception. Choices A, B, and C are important aspects of a health history but are not specific to the diagnosis of intussusception. Food allergies, bowel movements, and recent food intake are relevant for a comprehensive assessment but do not directly relate to the specific symptoms of intussusception.

2. A child is diagnosed with a Greenstick Fracture. Which of the following most accurately describes the broken bone?

• A. compound fracture of the fibula
• B. a partial break in a long bone
• C. fracture of the growth plate of the ulna near the wrist
• D. Colles fracture of the tibia

Correct answer: B

Rationale: A Greenstick Fracture is commonly found in children due to their bones being more flexible. This type of fracture occurs when a bone bends and partially breaks, resembling what happens when a green stick from a tree is bent in half. Therefore, the most accurate description of a Greenstick Fracture is 'a partial break in a long bone.' Choice A, 'compound fracture of the fibula,' is incorrect as a Greenstick Fracture is not a compound fracture. Choice C, 'fracture of the growth plate of the ulna near the wrist,' is incorrect as it describes a different type of fracture. Choice D, 'Colles fracture of the tibia,' is incorrect as it refers to a specific type of fracture in a different bone.

3. A patient is found unconscious in their room with rhythmic jerking of all four extremities and heavy foaming at the mouth. The patient was on seizure precautions with bedrails up and padded. What is the priority action for the nurse to take?

• A. Administer Lorazepam (Ativan)
• B. Turn the patient to his/her side
• C. Call the physician
• D. Suction the patient

Correct answer: B

Rationale: The nurse's priority action should be to turn the patient to his/her side. This position helps maintain an open airway and prevents aspiration of secretions or vomitus. Administering Lorazepam (Ativan) without ensuring a clear airway could lead to further complications. Calling the physician is important, but immediate interventions to protect the airway take precedence. Suctioning the patient may be necessary but should not be the initial action; positioning for airway protection is the priority.

4. Clinical manifestations of asthma include:

• A. Decreased expiratory time
• B. Increased peak expiratory flow
• C. Increased use of accessory muscles
• D. Increased oxygen saturation

Correct answer: C

Rationale: Clinical manifestations of asthma include increased use of accessory muscles, increased expiratory time, increased peak expiratory flow, and decreased oxygen saturation. Choice A, 'Decreased expiratory time,' is incorrect because asthma typically presents with increased expiratory time due to airway obstruction. Choice B, 'Increased peak expiratory flow,' is incorrect as asthma commonly leads to decreased peak expiratory flow due to airway constriction. Choice D, 'Increased oxygen saturation,' is incorrect because asthma exacerbations often result in decreased oxygen saturation levels.

5. A diabetic patient's arterial blood gas (ABG) results are pH 7.28; PaCO2 34 mm Hg; PaO2 85 mm Hg; HCO3 18 mEq/L. The nurse would expect which finding?

• A. Intercostal retractions
• B. Kussmaul respirations
• C. Low oxygen saturation (SpO2)
• D. Decreased venous O2 pressure

Correct answer: B

Rationale: Kussmaul respirations (deep and rapid) are a compensatory mechanism for metabolic acidosis. The low pH and low bicarbonate levels indicate metabolic acidosis. Intercostal retractions, low oxygen saturation, and decreased venous O2 pressure are not associated with acidosis. Intercostal retractions typically occur in respiratory distress, while low oxygen saturation and decreased venous O2 pressure are more related to respiratory or circulatory issues, not metabolic acidosis.

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