Nursing Elites

1. Which food should the assistive personnel be instructed to remove from the child's food tray based on the prescribed treatment for nephrotic syndrome?

• A. Pickle
• B. Wheat toast
• C. Baked chicken
• D. Steamed vegetables

Correct answer: A

Rationale: In nephrotic syndrome, a no-added-salt diet is recommended to manage the condition. High-sodium foods like pickles should be avoided as they can exacerbate fluid retention and swelling. Wheat toast, baked chicken, and steamed vegetables are generally suitable for individuals with nephrotic syndrome as they are low in sodium and protein, which are important considerations for this condition. Therefore, the correct choice is to remove the pickles from the child's food tray.

2. A patient is admitted to the emergency department with an open stab wound to the left chest. What is the first action that the nurse should take?

• A. Position the patient so that the left chest is dependent
• B. Tape a nonporous dressing on three sides over the chest wound
• C. Cover the sucking chest wound firmly with an occlusive dressing
• D. Keep the head of the patient's bed at no more than 30 degrees elevation

Correct answer: B

Rationale: The correct initial action for a patient with an open stab wound to the chest is to tape a nonporous dressing on three sides over the chest wound. This dressing technique allows air to escape during expiration but prevents air from entering the pleural space during inspiration, helping to prevent tension pneumothorax. Placing the patient so that the left chest is dependent or covering the wound with an occlusive dressing can trap air in the pleural space, leading to tension pneumothorax. Keeping the head of the bed elevated at 30 to 45 degrees helps facilitate breathing and is not the first action to take when managing an open chest wound.

3. The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure. Which assessment would best evaluate the effectiveness of the therapies?

• A. Observe for distended neck veins.
• B. Auscultate for crackles in the lungs.
• C. Palpate for heaves or thrills over the heart.
• D. Review hemoglobin and hematocrit values.

Correct answer: A

Rationale: To evaluate the effectiveness of therapies for cor pulmonale and right-sided heart failure, observing for distended neck veins would be the most appropriate assessment. Cor pulmonale is characterized by right ventricular failure due to pulmonary hypertension, leading to clinical manifestations such as peripheral edema, jugular venous distention, and right upper-quadrant abdominal tenderness. These signs indicate increased central venous pressure and right heart strain, which can be assessed by observing for distended neck veins. Auscultating for crackles in the lungs is more indicative of left-sided heart failure rather than right-sided heart failure. Heaves or thrills over the heart are not typically associated with cor pulmonale. Reviewing hemoglobin and hematocrit values may show elevations due to chronic hypoxemia and polycythemia in cor pulmonale, but these values alone do not directly evaluate the immediate effectiveness of the prescribed therapies on the patient's condition.

4. Mr. C is brought to the hospital with severe burns over 45% of his body. His heart rate is 124 bpm and thready, BP 84/46, respirations 24/minute and shallow. He is apprehensive and restless. Which of the following types of shock is Mr. C at highest risk for?

• A. Septic shock
• B. Hypovolemic shock
• C. Neurogenic shock
• D. Cardiogenic shock

Correct answer: B

Rationale: Mr. C, who has severe burns over 45% of his body, is at highest risk for hypovolemic shock. Burns lead to a loss of plasma volume, reducing the circulating fluid volume and impairing perfusion to vital organs and extremities. In this scenario, the signs of shock, such as increased heart rate, low blood pressure, shallow respirations, and restlessness, indicate a state of hypovolemic shock due to significant fluid loss. Septic shock (choice A) is primarily caused by severe infections, neurogenic shock (choice C) results from spinal cord injuries, and cardiogenic shock (choice D) stems from heart failure. However, in this case, the presentation aligns most closely with hypovolemic shock due to the extensive burn injury and its effects on fluid volume and perfusion.

5. After assessing Mr. B, what is the initial action of the nurse?

• A. Immediately place the client in a negative-pressure room
• B. Set the client up to receive a bronchoscopy
• C. Contact the physician for antifungal medications
• D. Administer oxygen and assist the client to sit in the semi-Fowler's position

Correct answer: A

Rationale: The first action the nurse should take after assessing Mr. B is to administer oxygen and assist him to sit in the semi-Fowler's position. Administering oxygen helps improve tissue oxygenation, while sitting up in a semi-Fowler's position aids in better breathing and secretion clearance. Placing the client in a negative-pressure room is not the immediate priority unless isolation is needed. Performing a bronchoscopy or contacting the physician for antifungal medications is not the initial step in managing a client with suspected pneumonia.

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