Nursing Elites

1. The clinic nurse reviews the record of an infant and notes that the primary healthcare provider 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 healthcare for the infant?

• A. Diarrhea
• B. Projectile vomiting
• C. Regurgitation of feedings
• D. Foul-smelling, ribbon-like stools

Correct answer: D

Rationale: Hirschsprung's disease, also known as congenital aganglionosis or aganglionic megacolon, is a congenital anomaly characterized by an absence of ganglion cells in the rectum and other areas of the affected intestine. A key clinical manifestation of Hirschsprung's disease is chronic constipation that starts in the first month of life, leading to pellet-like or ribbon-like stools that have a foul smell. Another sign is the delayed passage or absence of meconium stool in the neonatal period. In addition to foul-smelling, ribbon-like stools, bowel obstruction (especially in the neonatal period), abdominal pain and distention, and failure to thrive are also common clinical manifestations of this disorder. Options A, B, and C are not typically associated with Hirschsprung's disease, making them incorrect choices in this scenario.

2. A 3-year-old had a hip spica cast applied 2 hours ago. In order to facilitate drying, the nurse should

• A. Expose the cast to air and turn the child frequently
• B. Use a heat lamp to reduce the drying time
• C. Handle the cast with the abductor bar
• D. Turn the child as little as possible

Correct answer: A

Rationale: After applying a hip spica cast, it is important to facilitate drying by exposing the cast to air and turning the child frequently. This helps promote even drying and prevents complications such as skin breakdown. Using a heat lamp can cause burns and is not recommended. Handling the cast with the abductor bar does not aid in drying the cast. Turning the child as little as possible is incorrect as regular turning is crucial to prevent complications.

3. A client is receiving digoxin (Lanoxin) 0.25 mg daily. The health care provider has written a new order to give metoprolol (Lopressor) 25 mg B.I.D. In assessing the client prior to administering the medications, which of the following should the nurse report immediately to the health care provider?

• A. Blood pressure 94/60 mm Hg
• B. Heart rate 76 bpm
• C. Urine output 50 ml/hour
• D. Respiratory rate 16 bpm

Correct answer: A

Rationale: The correct answer is 'Blood pressure 94/60 mm Hg.' Both digoxin and metoprolol decrease the heart rate. Metoprolol specifically affects blood pressure. Therefore, the heart rate and blood pressure need to be within normal range (HR 60-100 bpm; systolic BP above 100 mm Hg) to safely administer both medications. A blood pressure of 94/60 mm Hg indicates hypotension, which could be exacerbated by metoprolol, necessitating immediate reporting to the healthcare provider. Choices B, C, and D are within normal limits and do not pose immediate risks related to the administration of these medications.

4. Which assessment finding is of most concern for a 46-year-old woman with acute pancreatitis?

• A. Absent bowel sounds
• B. Abdominal tenderness
• C. Left upper quadrant pain
• D. Palpable abdominal mass

Correct answer: D

Rationale: The correct answer is a palpable abdominal mass. In a 46-year-old woman with acute pancreatitis, a palpable abdominal mass may indicate the presence of a pancreatic abscess, which requires rapid surgical drainage to prevent sepsis. Absent bowel sounds, abdominal tenderness, and left upper quadrant pain are common symptoms in acute pancreatitis but do not necessarily indicate an immediate need for surgical intervention. Therefore, the presence of a palpable abdominal mass is the most concerning finding in this scenario.

5. A patient is scheduled for a magnetic resonance imaging (MRI) scan for suspected lung cancer. Which of the following is a contraindication to the study for this patient?

• A. The patient is allergic to shellfish.
• B. The patient has a pacemaker.
• C. The patient suffers from claustrophobia.
• D. The patient takes antipsychotic medication.

Correct answer: B

Rationale: The correct answer is that the patient has a pacemaker. A pacemaker is a contraindication to MRI scanning due to the interference with the magnetic fields of the MRI scanner. This interference can potentially deactivate the pacemaker, putting the patient at risk. Patients with cardiac implantable electronic devices (CIED) are at risk for inappropriate device therapy, device heating/movement, and arrhythmia during MRI. This necessitates special precautions such as scheduling in a CIED blocked slot or having electrophysiology nurse or technician support. It is important to ensure that the patient's pacemaker is MRI conditional before proceeding with the scan. The other choices, such as being allergic to shellfish, suffering from claustrophobia, or taking antipsychotic medication, are not direct contraindications to undergoing an MRI scan for suspected lung cancer.

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