Nursing Elites

1. The patient with bipolar disorder is being treated with lithium and has a new prescription for captopril for hypertension. The combination of these two drugs makes which assessment particularly important?

• A. Potassium level
• B. Lithium level
• C. Creatinine level
• D. Blood pressure

Correct answer: B

Rationale: When captopril, an ACE inhibitor, is combined with lithium, it can lead to lithium accumulation. Therefore, monitoring lithium levels is crucial to prevent toxicity. While ACE inhibitors like captopril can cause hyperkalemia, renal insufficiency, and hypotension, the risk of these effects is not increased by the combination of lithium and captopril.

2. Which assessment data would cause suspicion that a 3-year-old child has Hirschsprung disease?

• A. Clay-colored stools and dark urine
• B. History of early passage of meconium in the newborn period
• C. History of chronic, progressive constipation and failure to gain weight
• D. Continual bouts of foul-smelling diarrhea

Correct answer: C

Rationale: Hirschsprung disease is characterized by chronic, progressive constipation and failure to gain weight. These symptoms are indicative of the disorder due to the absence of ganglion cells in the distal colon, leading to impaired motility and obstruction.

3. When teaching an adolescent about managing tinea pedis, which statement indicates an understanding of the teaching?

• A. I should buy some plastic shoes to wear at the swimming pool
• B. I should wear sandals as much as possible
• C. I should place the permethrin cream between my toes twice daily
• D. I should seal my non-washable shoes in plastic bags for a couple of weeks

Correct answer: B

Rationale: Wearing sandals allows air circulation around the feet, reducing perspiration and eliminating the environment for bacteria and fungus to thrive. This promotes the healing of the fungal infection. Therefore, the correct answer is B.

4. A child with a history of seizures arrives in the emergency department (ED) in status epilepticus. Which is the priority nursing action?

• A. Take vital signs.
• B. Establish an intravenous line.
• C. Perform rapid neurologic assessment.
• D. Maintain a patent airway.

Correct answer: D

Rationale: When a child with a history of seizures presents in status epilepticus, the priority nursing action is to maintain a patent airway. This is crucial to ensure proper oxygenation and ventilation. While taking vital signs, establishing an intravenous line, and performing rapid neurologic assessment are important, maintaining a patent airway takes precedence. Hypoxia can lead to serious complications, making airway management the top priority to ensure the child's safety and prevent further deterioration.

5. A teacher states to the school nurse, 'I have a student who will often just stare at me for 15 seconds after asking a question; then the student blinks and asks me to repeat the question. Should I be concerned?' Which should the nurse include in the response to the teacher?

• A. The child has a crush on the teacher.
• B. The child has increased intracranial pressure.
• C. The child may have had a head injury.
• D. The child is experiencing absence seizures.

Correct answer: D

Rationale: Staring spells that end abruptly and are followed by normal activity are indicative of absence seizures. In absence seizures, a child may exhibit staring spells, brief loss of awareness, and lack of responsiveness, which can last for a few seconds. Choice A is incorrect because the behavior described is not associated with having a crush. Choice B is incorrect as increased intracranial pressure usually presents with other symptoms. Choice C is less likely as a head injury would typically manifest with additional signs beyond just staring and blinking.

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