Nursing Elites

1. For minimal change nephrotic syndrome (MCNS), prednisone is effective when what occurs?

• A. Appetite increases and blood pressure is normal
• B. Urinary tract infection is gone and edema subsides
• C. Generalized edema subsides and blood pressure is normal
• D. Diuresis occurs as urinary protein excretion diminishes

Correct answer: D

Rationale: The effectiveness of prednisone in treating MCNS is indicated by diuresis and a decrease in urinary protein excretion. Subsidence of generalized edema is also a positive sign, but the key indicator is the reduction in proteinuria, which is achieved through diuresis.

2. The school nurse is assessing children for risk factors related to childhood injuries. Which child has the most risk factors related to childhood injury?

• A. Female, multiple siblings, stable home life
• B. Male, high activity level, stressful home life
• C. Male, even-tempered, history of previous injuries
• D. Female, reacts negatively to new situations, no serious previous injuries

Correct answer: B

Rationale: A male child with a high activity level and a stressful home life has multiple risk factors for childhood injuries, requiring closer supervision and preventive measures.

3. What time frame has the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists recommended that pregnant adolescents and women who are not protected against pertussis receive the tetanus, diphtheria, and pertussis (Tdap) vaccine?

• A. Between 27 and 36 weeks of gestation or postpartum before discharge from the hospital
• B. During the first prenatal visit when pregnancy is confirmed
• C. The vaccine should be administered 24 hours prior to delivery
• D. This vaccine is only recommended during the first trimester

Correct answer: A

Rationale: The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists recommend that pregnant adolescents and women without protection against pertussis should receive the Tdap vaccine ideally between 27 and 36 weeks of gestation or postpartum before discharge from the hospital. This timeframe allows for the development of antibodies in the mother to protect her and provide passive immunity to the infant. Administering the vaccine during the first trimester (Choice D) is not recommended as the optimal time is between 27 and 36 weeks. Choice B, during the first prenatal visit, is too early for optimal protection, and Choice C, 24 hours prior to delivery, does not provide enough time for the vaccine to be effective before birth.

4. The nurse is teaching a child experiencing severe edema associated with minimal change nephrotic syndrome about his diet. The nurse should discuss what dietary need?

• A. Consuming a regular diet
• B. Increasing protein
• C. Restricting fluids
• D. Decreasing calories

Correct answer: C

Rationale: Fluid restriction is often necessary to manage severe edema associated with MCNS. Increasing protein is not typically recommended due to the risk of exacerbating proteinuria, and calorie reduction is not generally needed.

5. During an otoscopic examination on an infant, in which direction is the pinna pulled?

• A. Up and back
• B. Up and forward
• C. Down and back
• D. Down and forward

Correct answer: C

Rationale: For infants, the pinna is pulled down and back to straighten the ear canal and allow proper visualization of the tympanic membrane during otoscopic examination.

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