Nursing Elites

1. While auscultating a patient's lungs, the nurse hears low-pitched, bubbling sounds during inhalation in the lower third of both lungs. How should the nurse document this finding?

• A. Inspiratory crackles at the bases
• B. Expiratory wheezes in both lungs
• C. Abnormal lung sounds in the apices of both lungs
• D. Pleural friction rub in the right and left lower lobes

Correct answer: A

Rationale: The correct answer is 'Inspiratory crackles at the bases.' Crackles are low-pitched, bubbling sounds typically heard during inspiration, which aligns with the nurse's finding. Expiratory wheezes are high-pitched sounds and are not consistent with the described auscultation findings. The lower third of both lungs refers to the bases, not the apices, so option C is incorrect. Pleural friction rubs are grating sounds heard during both inspiration and expiration, unlike the described finding of only hearing the sounds during inhalation in the lower third of both lungs.

2. During an admission assessment on a 2-year-old child diagnosed with nephrotic syndrome, the nurse notes that which characteristic is most commonly associated with this syndrome?

• A. Hypertension
• B. Generalized edema
• C. Increased urinary output
• D. Frank, bright red blood in the urine

Correct answer: B

Rationale: Nephrotic syndrome in children is characterized by massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema. The most common manifestation is generalized edema due to protein loss in the urine, leading to decreased plasma oncotic pressure. This results in fluid shifting into the interstitial spaces, causing edema. Hypertension is not a typical feature of nephrotic syndrome in children. Increased urinary output is not a common finding; instead, children with nephrotic syndrome often have decreased urine output due to decreased renal perfusion. The presence of frank, bright red blood in the urine is not a typical characteristic of nephrotic syndrome but may indicate a different renal condition such as glomerulonephritis.

3. The clinic nurse reviews the record of an infant and notes that the primary health care provider (PHCP) has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which sign most likely led the mother to seek health care for the infant?

• A. Diarrhea
• B. Projectile vomiting
• C. Regurgitation of feedings
• D. Constipation

Correct answer: C

Rationale: Hirschsprung's disease, also known as congenital aganglionosis or aganglionic megacolon, is characterized by the absence of ganglion cells in the rectum and other parts of the affected intestine. Clinical manifestations of Hirschsprung's disease include chronic constipation with pellet-like or ribbon-like foul-smelling stools, delayed or absent passage of meconium in the neonatal period, bowel obstruction (especially in the neonatal period), abdominal pain and distention, and failure to thrive. In the case of an infant with suspected Hirschsprung's disease, regurgitation of feedings is a sign that may have led the mother to seek healthcare. This symptom can be associated with the bowel dysfunction and obstruction seen in Hirschsprung's disease. Options A, B, and D are not typically associated with Hirschsprung's disease. Diarrhea is not a common symptom, projectile vomiting is not a typical presentation, and constipation, while a symptom of the disease, is not the sign that would most likely prompt a visit to seek healthcare in an infant suspected of having Hirschsprung's disease.

4. A 24-year-old female contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, what would serologic testing most likely reveal?

• A. antibody to hepatitis D (anti-HDV).
• B. hepatitis B surface antigen (HBsAg).
• C. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG).
• D. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM).

Correct answer: D

Rationale: Hepatitis A is primarily transmitted through the oral-fecal route. During the acute phase of hepatitis A, serologic testing typically reveals anti-hepatitis A virus immunoglobulin M (anti-HAV IgM). This antibody appears early in the course of the infection. The presence of anti-HAV IgM indicates an acute infection with hepatitis A. Choices A and B are incorrect as hepatitis D and hepatitis B antigens are not typically associated with acute hepatitis A. Choice C, anti-hepatitis A virus immunoglobulin G (anti-HAV IgG), would indicate a past infection and lifelong immunity, which is not expected during the acute phase of the illness.

5. A patient has been diagnosed with acute gastritis in a clinic. Which of the following medications would be contraindicated for this patient?

• A. Naproxen sodium (Naprosyn)
• B. Calcium carbonate
• C. Clarithromycin (Biaxin)
• D. Furosemide (Lasix)

Correct answer: A

Rationale: Naproxen sodium is a nonsteroidal anti-inflammatory drug that can cause inflammation of the upper GI tract. For this reason, it is contraindicated in a patient with gastritis. Gastritis involves inflammation of the stomach lining, and medications like Naproxen can exacerbate this condition. Calcium carbonate is an antacid that can help neutralize stomach acid and may actually provide relief for gastritis symptoms. Clarithromycin is an antibiotic used to treat H. pylori infection, a common cause of gastritis. Furosemide is a loop diuretic used to treat conditions like edema and hypertension, not directly contraindicated in gastritis.

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