Nursing Elites

1. The nurse notes that a child has lost 3.6 kg (8 lb) after 4 days of hospitalization for acute glomerulonephritis. What is the most likely cause of this weight loss?

• A. Poor appetite
• B. Reduction of edema
• C. Restriction to bed rest
• D. Increased potassium intake

Correct answer: B

Rationale: The weight loss is most likely due to the reduction of edema, as glomerulonephritis often causes fluid retention that resolves with treatment, leading to significant weight loss.

2. Which congenital heart defect causes a "boot-shaped" heart on a chest x-ray?

• A. Tetralogy of Fallot
• B. Coarctation of the aorta
• C. Transposition of the great arteries
• D. Ventricular septal defect

Correct answer: A

Rationale: The correct answer is A: Tetralogy of Fallot. Tetralogy of Fallot, a congenital heart defect with four distinct abnormalities, often presents with a "boot-shaped" heart on chest x-ray due to right ventricular hypertrophy. This characteristic finding is due to the specific combination of defects in this condition. Coarctation of the aorta (choice B), Transposition of the great arteries (choice C), and Ventricular septal defect (choice D) do not typically result in a "boot-shaped" heart on a chest x-ray like Tetralogy of Fallot does.

3. The parent of a 2-week-old infant asks the nurse if fluoride supplements are necessary because the infant is exclusively breastfed. What is the nurse's best response?

• A. The infant needs to begin taking them now.
• B. Supplements are not needed if you drink fluoridated water.
• C. The infant may need to begin taking them at age 6 months.
• D. The infant can have infant cereal mixed with fluoridated water instead of supplements.

Correct answer: C

Rationale: Breastfed infants may need fluoride supplements starting at 6 months if they are not receiving fluoride from other sources, such as drinking water.

4. A child is admitted with renal failure. Which of these findings should the nurse expect?

• A. Decreased BUN
• B. Azotemia and oliguria
• C. Increased glomerular filtration rate (GFR)
• D. Polyuria and elevated creatinine clearance

Correct answer: B

Rationale: Azotemia (elevated BUN and creatinine) and oliguria (reduced urine output) are classic signs of renal failure, indicating impaired kidney function. In renal failure, the kidneys are unable to effectively filter waste products, leading to an increase in BUN and creatinine levels in the blood. Additionally, oliguria occurs due to decreased kidney function. Increased GFR (Choice C) is not expected in renal failure as it signifies improved kidney function, which is not the case in renal failure. Polyuria and elevated creatinine clearance (Choice D) are not typical findings in renal failure. Polyuria is more commonly associated with conditions like diabetes insipidus, while elevated creatinine clearance would indicate increased kidney function, which is contrary to the impaired function seen in renal failure.

5. Physiological anorexia in toddlerhood occurs because of:

• A. Decreased appetite and decreased nutritional need
• B. Decreased appetite and increased nutritional need
• C. Increased appetite and lack of food preferences
• D. Increased appetite and strong food preferences

Correct answer: A

Rationale: Physiological anorexia in toddlers occurs due to a decreased appetite as growth rates slow down. Choice A is correct because it aligns with the concept that toddlers experience a natural decrease in appetite as their growth rate decreases. Choices B, C, and D are incorrect because they suggest increased appetite or other factors not associated with physiological anorexia in toddlerhood.

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