Nursing Elites

1. The parents of a newborn male with hypospadias want their child circumcised. The best response by the nurse is to inform them that

• A. Circumcision is delayed so the foreskin can be used for the surgical repair
• B. This procedure is contraindicated because of the permanent defect
• C. There is no medical indication for performing a circumcision on any child
• D. The procedure should be performed as soon as the infant is stable

Correct answer: A

Rationale: Circumcision is delayed so the foreskin can be used for the surgical repair. Even if mild hypospadias is suspected, circumcision is not done to save the foreskin for surgical repair if needed. Choice B is incorrect because circumcision is not contraindicated due to a permanent defect; it is delayed for potential surgical needs. Choice C is incorrect as there are situations where a circumcision may be indicated for medical or cultural reasons. Choice D is incorrect because circumcision for hypospadias-related repair is not done immediately but rather delayed to preserve the foreskin for potential reconstructive surgery.

2. Which pathologic condition is described as 'increased intraocular pressure of the eye'?

• A. Detached Retina
• B. Fovea Centralis
• C. Presbyopia
• D. Glaucoma

Correct answer: D

Rationale: The correct answer is Glaucoma. Glaucoma is a condition characterized by increased intraocular pressure in the eye, which can lead to optic nerve damage, vision loss, and blindness if left untreated. Detached Retina (A), Fovea Centralis (B), and Presbyopia (C) are not conditions associated with increased intraocular pressure like Glaucoma. Detached Retina is a separation of the retina from its underlying tissue, Fovea Centralis is a part of the retina responsible for sharp central vision, and Presbyopia is an age-related condition affecting near vision due to the loss of flexibility in the eye's lens.

3. A nurse in the emergency department is observing a 4-year-old child for signs of increased intracranial pressure after a fall from a bicycle, resulting in head trauma. Which of the following signs or symptoms would be cause for concern?

• A. Bulging anterior fontanel
• B. Repeated vomiting
• C. Signs of sleepiness at 10 PM
• D. Inability to read short words from a distance of 18 inches

Correct answer: B

Rationale: Increased intracranial pressure after head trauma can lead to serious complications. Repeated vomiting is a concerning sign as it can indicate stimulation of the vomiting center within the brainstem due to increased pressure. This can be an early indicator of raised intracranial pressure and the need for urgent medical intervention. Bulging anterior fontanel may not be immediately apparent in a 4-year-old child and is more common in infants. Signs of sleepiness at a particular time of day are not specific to increased intracranial pressure. Inability to read short words from a distance of 18 inches may indicate vision problems but is not directly related to intracranial pressure.

4. A 20-year-old female attending college is found unconscious in her dorm room. She has a fever and a noticeable rash. She has just been admitted to the hospital. Which of the following tests is most likely to be performed first?

• A. Blood sugar check
• B. CT scan
• C. Blood cultures
• D. Arterial blood gases

Correct answer: C

Rationale: The most likely test to be performed first in this scenario is blood cultures. Blood cultures are crucial to investigate the fever and rash symptoms in an unconscious patient. This test is used to detect foreign invaders like bacteria, yeast, and other microorganisms in the blood, which could indicate a blood infection (bacteremia). A positive blood culture result confirms the presence of bacteria in the blood. A blood sugar check (choice A) may be important but is less likely to be the first test in this context. A CT scan (choice B) and arterial blood gases (choice D) are generally not the initial tests performed to investigate a fever and rash with altered mental status.

5. A patient's chart indicates a history of ketoacidosis. Which of the following would you not expect to see with this patient if this condition were acute?

• A. Vomiting
• B. Extreme Thirst
• C. Weight gain
• D. Acetone breath smell

Correct answer: C

Rationale: In acute ketoacidosis, a patient typically experiences rapid weight loss due to the body burning fat and muscle for energy in the absence of sufficient insulin. Therefore, weight gain would not be expected. Vomiting may occur due to the metabolic disturbances associated with ketoacidosis. Extreme thirst is a common symptom as the body tries to compensate for dehydration. Acetone breath smell is a classic sign of ketoacidosis as acetone is one of the ketones produced during this condition.

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