Nursing Elites

1. The nurse is discussing negativism with the parents of a 30-month-old child. How should the nurse advise the parents to best respond to this behavior?

• A. Reprimand the child and give a 15-minute 'time out'
• B. Maintain a permissive attitude for this behavior
• C. Use patience and a sense of humor to deal with this behavior
• D. Assert authority over the child through limit setting

Correct answer: C

Rationale: Use patience and a sense of humor to deal with this behavior. The nurse should help the parents understand that negativism is a normal part of a toddler's growth towards autonomy. Reacting with patience and humor can help diffuse the situation and maintain a positive relationship with the child. Reprimanding the child and giving a 'time out' (Choice A) may not be effective for addressing negativism and can lead to power struggles. Maintaining a permissive attitude (Choice B) may reinforce negative behavior. Asserting authority through limit setting (Choice D) may be necessary in some situations, but using patience and humor is a more effective initial approach for handling negativism.

2. When assessing a patient suspected to have Hepatitis, a nurse notes the patient's eyes are yellow-tinged. Which of the following diagnostic results would further assist in confirming this diagnosis?

• A. Decreased serum Bilirubin
• B. Elevated serum ALT levels
• C. Low RBC and Hemoglobin with increased WBCs
• D. Increased Blood Urea Nitrogen level

Correct answer: B

Rationale: Elevated serum ALT levels would further confirm the diagnosis of Hepatitis. ALT is a liver enzyme, and hepatitis is a liver disease. Elevated liver enzymes, such as ALT, often indicate liver damage. Choice A, 'Decreased serum Bilirubin,' is incorrect as elevated bilirubin levels are typically seen in hepatitis due to impaired bilirubin metabolism. Choices C and D are unrelated to confirming a diagnosis of hepatitis as they describe findings not specific to liver function or hepatitis. Low RBC and Hemoglobin with increased WBCs (Choice C) suggest a different condition like anemia or infection, not specific to liver disease. Increased Blood Urea Nitrogen level (Choice D) is more indicative of kidney function rather than liver function, thus not helpful in confirming hepatitis.

3. A 34-year-old female has recently been diagnosed with an autoimmune disease. She has also recently discovered that she is pregnant. Which of the following is the only immunoglobulin that will provide protection to the fetus in the womb?

• A. IgA
• B. IgD
• C. IgE
• D. IgG

Correct answer: D

Rationale: IgG is the only immunoglobulin that can cross the placental barrier, providing passive immunity to the fetus. About 70-80% of the immunoglobulins in the blood are IgG. Specific IgG antibodies are generated after an initial exposure to an antigen, offering long-term protection against microorganisms. IgG antibodies are critical for protecting the fetus as they can be rapidly reproduced upon re-exposure to the same antigen. IgA is primarily found in mucosal areas, IgD is involved in antigen recognition, and IgE is associated with allergic reactions, but they do not provide the same level of protection to the fetus as IgG.

4. The nurse is caring for a woman 2 hours after a vaginal delivery. Documentation indicates that the membranes were ruptured for 36 hours prior to delivery. What are the priority nursing diagnoses at this time?

• A. Altered tissue perfusion
• B. Risk for fluid volume deficit
• C. High risk for hemorrhage
• D. Risk for infection

Correct answer: D

Rationale: The correct answer is 'Risk for infection.' When the membranes are ruptured for more than 24 hours prior to birth, there is a significantly increased risk of infection for both the mother and the newborn. Monitoring for signs of infection, such as fever, foul-smelling vaginal discharge, and uterine tenderness, is crucial. Option A, 'Altered tissue perfusion,' is not the priority in this scenario as infection risk takes precedence due to the prolonged rupture of membranes. Option B, 'Risk for fluid volume deficit,' is less of a priority compared to the immediate risk of infection. Option C, 'High risk for hemorrhage,' is not the priority concern at this time based on the information provided.

5. A child weighing 30 kg arrives at the clinic with diffuse itching as the result of an allergic reaction to an insect bite. Diphenhydramine (Benadryl) 25 mg 3 times a day is prescribed. The correct pediatric dose is 5 mg/kg/day. Which of the following best describes the prescribed drug dose?

• A. It is the correct dose
• B. The dose is too low
• C. The dose is too high
• D. The dose should be increased or decreased, depending on the symptoms

Correct answer: B

Rationale: The correct pediatric dose of diphenhydramine is 5 mg/kg/day. This child weighs 30 kg, so the calculated dose would be 5 mg/kg x 30 kg = 150 mg/day. Since the prescription is for 25 mg 3 times a day, the total daily dose is 25 mg x 3 = 75 mg/day, which is lower than the calculated dose of 150 mg/day. Therefore, the prescribed dose of 25 mg 3 times a day is too low for this child. The dose should be adjusted to meet the correct dosage of 150 mg/day, which would be 50 mg 3 times a day. It is important not to titrate the dosage based on symptoms without consulting a physician, as this can lead to inappropriate medication administration.

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