Nursing Elites

1. The nurse is conducting intake interviews of children at a city clinic. Which child is most susceptible to lead poisoning?

• A. An 8-year-old who lives in a housing project.
• B. A 2-year-old who plays on aging playground equipment.
• C. An adolescent who works in a paint factory.
• D. A 10-year-old with Type 1 diabetes.

Correct answer: B

Rationale: The correct answer is B. Young children, like the 2-year-old playing on aging playground equipment, are at higher risk of lead poisoning due to their hand-to-mouth behavior and exploration of their environment. Aging playground equipment may have lead-based paint that can be ingested by the child. While children living in housing projects are also at risk due to lead-based paint in older buildings, the 2-year-old child playing on potentially lead-contaminated playground equipment is the most susceptible in this scenario. The adolescent working in a paint factory may face occupational hazards related to lead exposure, but the immediate risk from environmental sources is higher for the 2-year-old. Type 1 diabetes in a 10-year-old is not directly linked to an increased susceptibility to lead poisoning.

2. A client at 12 weeks gestation is admitted to the antepartum unit with a diagnosis of hyperemesis gravidarum. Which action is most important for the nurse to implement?

• A. Provide emotional support
• B. Monitor daily weight
• C. Encourage small frequent meals
• D. Initiate prescribed intravenous fluids

Correct answer: D

Rationale: Hyperemesis gravidarum, characterized by severe nausea and vomiting, leads to dehydration and electrolyte imbalances. The priority intervention is initiating IV fluids to correct these imbalances. Providing emotional support is important for the client's well-being, but addressing fluid and electrolyte imbalances takes precedence. Monitoring daily weight and encouraging small frequent meals are beneficial interventions but are not the priority when managing hyperemesis gravidarum.

3. In the critical care unit, which client should receive the most care hours by a registered nurse (RN)?

• A. A client with a newly inserted Foley catheter and Alzheimer's disease
• B. A 55-year-old with chronic kidney disease
• C. An 82-year-old client with a newly fractured femur and soft wrist restraints
• D. A 72-year-old with pneumonia and sepsis on antibiotics

Correct answer: C

Rationale: The client with a newly fractured femur and soft wrist restraints should receive the most care hours as they have physical limitations due to the fracture and mental limitations due to being restrained. This client requires continuous monitoring, support, and frequent assessments to prevent complications. Choices A, B, and D do not have the same level of physical and mental care needs as the client with the newly fractured femur and soft wrist restraints.

4. An adult male is brought to the ER after a motorcycle accident with periorbital bruising and bloody drainage from both ears. Which finding requires immediate attention?

• A. Rebound abdominal tenderness.
• B. Diminished breath sounds bilaterally.
• C. Rib pain with deep inspiration.
• D. Projectile vomiting.

Correct answer: D

Rationale: In this scenario, the patient's periorbital bruising and bloody drainage from both ears suggest a severe head injury. Projectile vomiting is a red flag symptom that may indicate increased intracranial pressure, which requires immediate attention to prevent further neurological deterioration. Rebound abdominal tenderness (choice A) typically indicates peritonitis and is not directly related to the primary head injury. Diminished breath sounds bilaterally (choice B) suggest a pneumothorax or hemothorax, which are important but not as immediately life-threatening in this context. Rib pain with deep inspiration (choice C) is concerning for rib fractures or pulmonary contusion, which are also important but do not take precedence over addressing the potential increased intracranial pressure.

5. A client with liver cirrhosis is receiving lactulose for hepatic encephalopathy. Which finding indicates the medication is effective?

• A. The client's level of consciousness improves.
• B. The client's ammonia level decreases.
• C. The client has three bowel movements daily.
• D. The client's liver enzymes return to normal.

Correct answer: B

Rationale: The correct answer is B: "The client's ammonia level decreases." In hepatic encephalopathy, elevated ammonia levels contribute to neurological symptoms. Lactulose works by promoting the excretion of ammonia in the stool, leading to decreased serum ammonia levels. Therefore, a decrease in ammonia levels indicates that lactulose is effectively reducing ammonia buildup, improving hepatic encephalopathy symptoms. Choices A, C, and D are incorrect because improvement in level of consciousness, bowel movements, or normalization of liver enzymes may not directly reflect the effectiveness of lactulose in reducing ammonia levels and improving hepatic encephalopathy.

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