Nursing Elites

1. Parents of a 6-month-old breastfed baby ask the nurse about increasing the baby's diet. Which of the following should be added first?

• A. Cereal
• B. Eggs
• C. Meat
• D. Juice

Correct answer: A

Rationale: The correct answer is 'Cereal.' The guidelines of the American Academy of Pediatrics recommend introducing one new food at a time, starting with strained cereal. Cereal is often recommended as a first solid food for infants due to its soft texture and iron-fortified properties, which are important for the baby's development. Eggs and meat are common allergenic foods and are usually introduced later. Juice is not recommended for infants under 1 year old due to its high sugar content and lack of nutritional value compared to whole fruits.

2. Which of the following is the most common type of malignant brain tumor in the United States?

• A. Meningioma
• B. Glioblastoma multiforme
• C. Acoustic neuroma
• D. Pituitary adenoma

Correct answer: B

Rationale: Glioblastoma multiforme is the most common malignant brain tumor in the United States, accounting for a significant portion of cases. It is known for its aggressive nature and poor prognosis. Surgical resection, followed by radiation and chemotherapy, is the standard treatment approach for glioblastoma multiforme. Meningioma, acoustic neuroma, and pituitary adenoma are also types of brain tumors but are not as common as glioblastoma multiforme in the United States.

3. The nurse is caring for a 36-year-old patient with pancreatic cancer. Which nursing action is the highest priority?

• A. Offer psychological support for depression.
• B. Offer high-calorie, high-protein dietary choices.
• C. Administer prescribed opioids to relieve pain as needed.
• D. Teach about the need to avoid scratching any pruritic areas.

Correct answer: C

Rationale: The correct answer is to administer prescribed opioids to relieve pain as needed. Pain management is the highest priority in this scenario as effective pain control is essential for the patient's overall well-being. Pain relief will not only improve the patient's comfort but also enhance their ability to eat, follow dietary recommendations, and be open to psychological support. Offering psychological support for depression (Choice A) is important but addressing pain takes precedence. While providing high-calorie, high-protein dietary choices (Choice B) is crucial, it is secondary to managing pain. Teaching about the need to avoid scratching pruritic areas (Choice D) is relevant but not the highest priority in this situation where pain management is critical for the patient's quality of life.

4. The nurse reviews the record of a child who is suspected to have glomerulonephritis. Which statement by the child's parent should the nurse expect that is associated with this diagnosis?

• A. ''His pediatrician said his kidneys are working well.''
• B. ''I noticed his urine was the color of cola lately.''
• C. ''I'm so glad they didn't find any protein in his urine.''
• D. ''The nurse who admitted my child said his blood pressure was low.''

Correct answer: B

Rationale: Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Gross hematuria, resulting in dark, smoky, cola-colored, or brown-colored urine, is a classic symptom of glomerulonephritis. Blood urea nitrogen levels and serum creatinine levels may be elevated, indicating that kidney function is compromised. A mild to moderate elevation in protein in the urine is associated with glomerulonephritis. Hypertension is also common because of fluid volume overload secondary to the kidneys not working properly. Therefore, the parent's statement about noticing cola-colored urine aligns with the expected symptom in glomerulonephritis. The other options are less indicative of glomerulonephritis: choice A indicates normal kidney function, choice C mentions absence of protein in the urine (which is not expected in glomerulonephritis), and choice D talks about low blood pressure (hypertension is more common in glomerulonephritis).

5. A 4-year-old child with acute glomerulonephritis is admitted to the hospital. The nurse identifies which client problem in the plan of care as the priority?

• A. Infection related to hypertension
• B. Injury related to loss of blood in urine
• C. Excessive fluid volume related to decreased plasma filtration
• D. Retarded growth and development related to a chronic disease

Correct answer: C

Rationale: In acute glomerulonephritis, the child experiences excessive accumulation of water and retention of sodium, leading to circulatory congestion and edema. Excessive fluid volume is a primary concern due to the disease process. Hypertension and infection are not directly related to acute glomerulonephritis; therefore, they are not the priority client problems. While hematuria (blood in urine) may occur, it typically does not lead to significant injury that takes precedence over excessive fluid volume. Acute glomerulonephritis is an acute condition, not chronic; therefore, retarded growth and development related to a chronic disease is not the priority issue. With proper management, most children recover completely without long-term growth and development issues.

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