Nursing Elites

1. The nurse plans to closely monitor for which clinical manifestation after administering furosemide (Lasix)?

• A. Decrease pulse
• B. Decrease temperature
• C. Decrease BP
• D. Decrease respiratory rate.

Correct answer: C

Rationale: High-ceiling diuretics, such as furosemide, are the most effective diuretic agents. They produce more loss of fluid and electrolytes than any others. A sudden loss of fluid can result in decreased BP. When BP drops, the pulse will probably increase rather than decrease.

2. Which clinical manifestation should a nurse monitor for when assessing a pediatric client diagnosed with a basilar skull fracture?

• A. Periorbital ecchymosis
• B. Subdural hematoma
• C. Protruding bone
• D. Epidural hematoma

Correct answer: A

Rationale: Periorbital ecchymosis, also known as raccoon eyes, is a classic sign of a basilar skull fracture. It presents as bruising around the eyes due to blood collecting in the tissues. Monitoring for periorbital ecchymosis is crucial in assessing a pediatric client with a basilar skull fracture because it can indicate the presence of this serious injury.

3. How does an occupational therapist use clinical guidelines to inform practice with children and youth?

• A. Modify guidelines to fit the specific environment
• B. Establish systems to monitor outcomes
• C. Select the most recent guidelines without considering the client
• D. Consider guidelines that fit one's clientele and environment

Correct answer: C

Rationale: When using clinical guidelines to inform practice with children and youth, it is crucial for occupational therapists to not solely rely on the most recent guidelines but to consider the individual needs and contexts of each client. Selecting guidelines based solely on recency without considering the specific client can lead to ineffective or inappropriate interventions.

4. When preparing an adolescent for a lumbar puncture, which of the following actions should the nurse take?

• A. Place a cardiac monitor on the adolescent prior to the procedure
• B. Apply topical analgesic cream to the site one hour prior to the procedure
• C. Keep the adolescent in a semi-Fowler's position for 4 hours following the procedure
• D. Restrict fluids for 2 hours following the procedure

Correct answer: B

Rationale: The correct action for the nurse when preparing an adolescent for a lumbar puncture is to apply topical analgesic cream to the site one hour before the procedure. This helps reduce pain experienced during the lumbar puncture, making the procedure more comfortable for the adolescent. Placing a cardiac monitor on the adolescent is not necessary for a lumbar puncture. Keeping the adolescent in a semi-Fowler's position for 4 hours following the procedure is not a standard practice after a lumbar puncture. Restricting fluids for 2 hours following the procedure is not a requirement for a lumbar puncture preparation.

5. When planning care for a newborn with esophageal atresia and tracheoesophageal fistula, which is the priority nursing diagnosis?

• A. Ineffective Tissue Perfusion
• B. Ineffective Infant Feeding Pattern
• C. Acute Pain
• D. Risk for Aspiration

Correct answer: D

Rationale: The priority nursing diagnosis for a newborn with esophageal atresia and tracheoesophageal fistula is 'Risk for Aspiration' because of the potential respiratory complications associated with these conditions. The newborn is at a higher risk of aspirating oral or gastric contents due to the abnormal connections between the esophagus and trachea, posing a serious threat to the airway and lungs. Addressing this risk is crucial to prevent respiratory distress and maintain the airway's patency, making it the priority nursing diagnosis in this scenario. 'Ineffective Tissue Perfusion' is not the priority as respiratory compromise takes precedence over perfusion concerns. 'Ineffective Infant Feeding Pattern' may be relevant but addressing the risk of aspiration is more critical. 'Acute Pain' is not the priority compared to the life-threatening risk of aspiration.

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