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 client is in need of hemodialysis for end-stage renal failure. The physician has inserted an AV fistula. Which of the following nursing interventions is appropriate when caring for this access site?

• A. Assess for clotting in fistula tubing
• B. Apply a dressing over the fistula site
• C. Assess for a bruit or thrill at the site of the fistula
• D. Assess circulation proximal to the fistula site

Correct answer: A

Rationale: When caring for an AV fistula used for hemodialysis, it is important to assess for a bruit (a humming sound) or thrill (a vibrating sensation) at the site of the fistula. These indicate proper blood flow through the fistula, ensuring it is patent and suitable for hemodialysis. Assessing for clotting in fistula tubing (Choice A) is not a routine nursing intervention for AV fistulas. Applying a dressing over the fistula site (Choice B) is not necessary as the site needs to be accessible for hemodialysis. Assessing circulation proximal to the fistula site (Choice D) is important but not specific to caring for the access site of an AV fistula.

3. The nurse is caring for a newborn with a suspected diagnosis of imperforate anus. The nurse monitors the infant, knowing that which is a clinical manifestation associated with this disorder?

• A. Bile-stained fecal emesis
• B. The passage of currant jelly-like stools
• C. Failure to pass meconium stool in the first 24 hours after birth
• D. Sausage-shaped mass palpated in the upper right abdominal quadrant

Correct answer: C

Rationale: Imperforate anus is the incomplete development or absence of the anus in its normal position in the perineum. Failure to pass meconium stool within the first 24 hours after birth is a key clinical manifestation associated with this disorder. This finding should prompt further assessment to confirm the suspected diagnosis. Other assessment findings in imperforate anus may include absence or stenosis of the anal rectal canal, presence of an anal membrane, and an external fistula to the perineum. Options A, B, and D describe findings typically noted in intussusception, a different condition characterized by bowel obstruction and telescoping of the intestines that can present with bile-stained fecal emesis, the passage of currant jelly-like stools, and a sausage-shaped mass palpated in the upper right abdominal quadrant.

4. The patient who has two fractured ribs from an automobile accident is receiving discharge teaching. Which statement by the patient indicates effective teaching?

• A. I am going to buy a rib binder to wear during the day.
• B. I can take shallow breaths to prevent my chest from hurting.
• C. I should plan on taking the pain pills only at bedtime so I can sleep.
• D. I will use the incentive spirometer every hour or two during the day.

Correct answer: D

Rationale: The correct answer is, 'I will use the incentive spirometer every hour or two during the day.' After sustaining rib fractures, it is crucial to prevent complications like atelectasis and pneumonia by practicing deep breathing and coughing. Using the incentive spirometer helps in maintaining lung expansion and preventing respiratory issues. Buying a rib binder could restrict chest expansion and hinder deep breathing efforts, increasing the risk of atelectasis. Taking shallow breaths may not effectively expand the lungs, leading to potential respiratory complications. Relying solely on pain medication at bedtime may not adequately address the need for lung expansion and prevention of respiratory complications during the day.

5. In a 24-year-old woman, the term used to define uterine bleeding in which there is no menstruation is:

• A. Oligomenorrhea
• B. Amenorrhea
• C. Menorrhagia
• D. Metrorrhagia

Correct answer: B

Rationale: Amenorrhea is the correct term for the absence of menstrual periods in a woman of childbearing age. It is typically defined as no menstruation for at least three consecutive cycles or six months. Oligomenorrhea refers to infrequent or irregular menstrual periods rather than complete absence. Menorrhagia is characterized by excessive menstrual bleeding, not the absence of menstruation. Metrorrhagia involves irregular, acyclic bleeding between menstrual periods, which is different from the absence of menstruation.

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