Nursing Elites

1. What is the most appropriate suggestion regarding the diet for an 18-month-old child experiencing mild diarrhea and 'mushy' stools, but tolerating fluids and solid foods?

• A. Applesauce, bananas, wheat toast
• B. Mashed potatoes with baked chicken
• C. Gelatin, strained cabbage, and custard
• D. Fluids only until the 'mushy' stools stop

Correct answer: B

Rationale: For a child with mild diarrhea who is tolerating fluids and solid foods, the most appropriate diet suggestion would be to continue feeding a normal diet to prevent dehydration, reduce stool frequency and volume, and hasten recovery. Foods that are well tolerated during diarrhea include bland but nutritional options like complex carbohydrates (rice, wheat, potatoes, cereals), yogurt with live cultures, cooked vegetables, and lean meats. Mashed potatoes with baked chicken provide a balance of nutrients and are easy on the digestive system. Options A and C contain foods that may worsen diarrhea; applesauce and gelatin can be high in sugars which can exacerbate diarrhea, and cabbage may be hard to digest for some individuals. Option D of offering fluids only can affect the child's nutritional status by not providing enough essential nutrients during the recovery period.

2. Which assessment information will be most important for the nurse to report to the healthcare provider about a patient with acute cholecystitis?

• A. The patient's urine is bright yellow
• B. The patient's stools are tan colored
• C. The patient has increased pain after eating
• D. The patient complains of chronic heartburn

Correct answer: B

Rationale: The correct answer is that the patient's stools are tan colored. Tan or grey stools indicate biliary obstruction, which requires rapid intervention to resolve in a patient with acute cholecystitis. This change in stool color is a critical sign that the healthcare provider needs to be informed about promptly. The other choices are less concerning and may be common symptoms in patients with acute cholecystitis, but tan-colored stools specifically indicate a potential serious complication that warrants immediate attention.

3. The patient with chronic pancreatitis will be taught to take the prescribed pancrelipase (Viokase)

• A. at bedtime.
• B. in the morning.
• C. with each meal.
• D. for abdominal pain.

Correct answer: C

Rationale: The correct answer is to take pancrelipase (Viokase) with each meal. Pancrelipase is a pancreatic enzyme replacement medication that helps with the digestion of nutrients. Patients with chronic pancreatitis often have difficulty digesting food properly due to insufficient pancreatic enzyme production. Taking pancrelipase with each meal assists in the breakdown of fats, proteins, and carbohydrates consumed during the meal. Option A ('at bedtime') is incorrect because enzymes should be taken with meals to aid in digestion. Option B ('in the morning') is not ideal as it does not ensure optimal enzyme activity during meals. Option D ('for abdominal pain') is incorrect as pancrelipase is not meant to be taken solely for pain relief but rather to aid in digestion.

4. When assessing a child admitted to the hospital with pyloric stenosis, which symptom would the nurse likely find when asking the parent about the child's symptoms?

• A. Watery diarrhea
• B. Projectile vomiting
• C. Increased urine output
• D. Vomiting large amounts of bile

Correct answer: B

Rationale: In pyloric stenosis, hypertrophy of the circular muscles of the pylorus causes narrowing of the pyloric canal between the stomach and the duodenum. The hallmark symptom of pyloric stenosis is projectile vomiting, which is the forceful expulsion of stomach contents. Other common symptoms include irritability, hunger and crying, constipation, and signs of dehydration. Watery diarrhea (Choice A) is not a typical symptom of pyloric stenosis. Increased urine output (Choice C) is not directly associated with this condition. Vomiting large amounts of bile (Choice D) is not a characteristic symptom of pyloric stenosis; instead, the vomitus in pyloric stenosis is non-bilious.

5. The nurse plans health care for a community with a large number of recent immigrants from Vietnam. Which intervention is the most important for the nurse to implement?

• A. Hepatitis testing
• B. Tuberculosis screening
• C. Contraceptive teaching
• D. Colonoscopy information

Correct answer: B

Rationale: Tuberculosis (TB) is prevalent in many parts of Asia, including Vietnam, and the incidence of TB is higher in immigrants from Vietnam compared to the general U.S. population. Conducting tuberculosis screening is crucial to identify and address any cases promptly, especially in a community with recent immigrants from Vietnam. While teaching about contraceptive use, providing colonoscopy information, and testing for hepatitis may be relevant for certain individuals in the community, they are not as universally important as tuberculosis screening due to the increased risk of TB among Vietnamese immigrants.

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