Nursing Elites

1. The nurse has been assigned to care for a neonate just delivered who has gastroschisis. Which concern should the nurse address in the client's plan of care?

• A. Infection.
• B. Poor body image.
• C. Decreased urinary elimination.
• D. Cracking oral mucous membranes.

Correct answer: A

Rationale: In a neonate with gastroschisis, the bowel herniates through a defect in the abdominal wall without a covering membrane, which puts the neonate at high risk of infection. Immediate surgical repair is necessary due to the vulnerability of the exposed bowel to infection. Therefore, the most critical concern for the nurse to address in the plan of care of a neonate with gastroschisis is preventing infection. Poor body image is not a priority in neonatal care as neonates do not have body image concerns. Decreased urinary elimination is not typically a direct consequence of gastroschisis as it primarily affects the gastrointestinal system, not the genitourinary system. Cracking oral mucous membranes are not relevant to gastroschisis as it involves the lower gastrointestinal system, not the oral cavity.

2. A patient underwent fiberoptic colonoscopy 18 hours ago and presents to the emergency department with increasing abdominal pain, fever, and chills. Which of the following conditions poses the most immediate concern?

• A. Bowel perforation
• B. Viral gastroenteritis
• C. Colon cancer
• D. Diverticulitis

Correct answer: A

Rationale: The correct answer is bowel perforation. Bowel perforation is the most serious complication of fiberoptic colonoscopy, with signs such as progressive abdominal pain, fever, chills, and tachycardia indicating advancing peritonitis. Although colonoscopic perforation is rare (0.03% to 0.7% incidence), it can lead to high mortality and morbidity rates. Viral gastroenteritis (Choice B) typically presents with symptoms like diarrhea, nausea, vomiting, and abdominal cramps, but it is not the most immediate concern in this scenario. Colon cancer (Choice C) and diverticulitis (Choice D) are important conditions but are less likely to present acutely after colonoscopy compared to bowel perforation.

3. A newborn infant in the nursery has developed vomiting, poor feeding, lethargy, and respiratory distress, and has been diagnosed with necrotizing enterocolitis. Which of the following nursing interventions is most appropriate for this infant?

• A. Feed the infant 30 cc of sterile water
• B. Position the infant on his back
• C. Administer antibiotics as ordered
• D. Allow the infant to breastfeed

Correct answer: C

Rationale: Necrotizing enterocolitis (NEC) is a serious condition characterized by ischemic bowel, leading to gastrointestinal symptoms, lethargy, poor feeding, and respiratory distress. In the management of NEC, it is crucial to stop oral feedings, insert a nasogastric tube for decompression, and administer antibiotics as prescribed by the physician. Therefore, the most appropriate nursing intervention for an infant with NEC is to administer antibiotics as ordered. Choice A, feeding the infant sterile water, is incorrect because oral feedings should be stopped in NEC. Choice B, positioning the infant on his back, is not directly related to the treatment of NEC. Choice D, allowing the infant to breastfeed, is contraindicated in NEC as oral feedings should be ceased to prevent further complications.

4. Which patient poses the least infection risk to an immunosuppressed patient who had a liver transplant?

• A. The patient with chronic pancreatitis
• B. The patient currently infected with a respiratory virus
• C. The patient with a healing leg wound
• D. The patient with a urinary tract infection

Correct answer: C

Rationale: The patient with a healing leg wound poses the least infection risk to an immunosuppressed patient who had a liver transplant. Chronic pancreatitis can lead to complications such as infections that can pose a risk to immunosuppressed individuals. Patients infected with respiratory viruses or urinary tract infections are actively infectious, which can put immunosuppressed patients at a higher risk of acquiring infections. Therefore, the patient with a healing leg wound is the least likely to pose an immediate infection risk.

5. A client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA). The nurse knows that a PTCA is:

• A. Surgical repair of a diseased coronary artery
• B. Placement of an automatic internal cardiac defibrillator
• C. Procedure that compresses plaque against the wall of the diseased coronary artery to improve blood flow
• D. Non-invasive radiographic examination of the heart

Correct answer: C

Rationale: Percutaneous transluminal coronary angioplasty (PTCA) is a procedure that compresses plaque against the wall of the diseased coronary artery to improve blood flow. It is performed during a cardiac catheterization to improve coronary artery blood flow in a diseased artery. Surgical repair of a diseased coronary artery is typically done through procedures like aorto-coronary bypass graft (ACBG) rather than PTCA. Placement of an automatic internal cardiac defibrillator (AICD) is a different procedure used for managing cardiac arrhythmias. Non-invasive radiographic examination of the heart refers to procedures like echocardiography or cardiac MRI, not PTCA.

Similar Questions