Nursing Elites

1. The pediatric clinic nurse examines a toddler with a tentative diagnosis of neuroblastoma. Findings observed by the nurse that are associated with this problem include which of these?

• A. Lymphedema and nerve palsy
• B. Hearing loss and ataxia
• C. Headaches and vomiting
• D. Abdominal mass and weakness

Correct answer: D

Rationale: Neuroblastoma, a common solid tumor in children, often presents with symptoms related to the mass effect it causes. Abdominal mass and weakness are classic signs of neuroblastoma due to the tumor originating in the adrenal glands near the kidneys and potentially compressing nearby structures. Lymphedema and nerve palsy (Choice A) are not typically associated with neuroblastoma. Hearing loss and ataxia (Choice B) are more common in conditions affecting the central nervous system rather than neuroblastoma. Headaches and vomiting (Choice C) are nonspecific symptoms and are less commonly linked to neuroblastoma compared to the characteristic abdominal findings.

2. A client with amphetamine toxicity and sensory overload is being cared for by a nurse. Which intervention should the nurse implement?

• A. Immediately conduct a thorough assessment.
• B. Encourage visitors to distract the client.
• C. Provide a private room and limit stimulation.
• D. Speak softly to the client.

Correct answer: C

Rationale: The most appropriate intervention for a client with amphetamine toxicity and sensory overload is to provide a private room and limit stimulation. This approach helps reduce external stimuli, which can exacerbate sensory overload, and creates a calming environment for the client. Encouraging visitors to distract the client may worsen sensory overload by adding more stimulation. Speaking softly, rather than at a higher volume, is more suitable to help maintain a calm environment. Therefore, the correct choice is to provide a private room and limit stimulation (option C) in this scenario.

3. An elderly resident of a long-term care facility is no longer able to perform self-care and is becoming progressively weaker. The resident previously requested that no resuscitative efforts be performed, and the family requests hospice care. What action should the LPN/LVN implement first?

• A. Reaffirm the client's desire for no resuscitative efforts.
• B. Transfer the client to a hospice inpatient facility.
• C. Prepare the family for the client's impending death.
• D. Notify the healthcare provider of the family's request.

Correct answer: D

Rationale: The first action the LPN/LVN should implement is to notify the healthcare provider of the family's request. This is crucial to ensure that appropriate steps are taken to address the family's request for hospice care and to coordinate the necessary care for the resident. While reaffirming the client's desire for no resuscitative efforts is important, notifying the healthcare provider takes precedence in this situation. Transferring the client to a hospice inpatient facility and preparing the family for the client's impending death are significant actions but should be done after notifying the healthcare provider to ensure proper coordination of care.

4. During a health assessment, a client who takes herbal supplements makes a statement indicating an understanding of their use. Which statement is most indicative of this understanding?

• A. I use garlic for my menopausal symptoms.
• B. I use ginger when I get car sick.
• C. I take ginkgo biloba for headaches.
• D. I take echinacea to control cholesterol.

Correct answer: C

Rationale: The correct answer is C because ginkgo biloba is commonly used to help with headaches, among other benefits. Choices A, B, and D are incorrect because garlic is not typically used for menopausal symptoms, ginger is mainly used for nausea and vomiting (not car sickness specifically), and echinacea is not known to control cholesterol.

5. When evaluating a client's plan of care, the LPN determines that a desired outcome was not achieved. Which action will the LPN implement first?

• A. Establish a new nursing diagnosis.
• B. Note which actions were not implemented.
• C. Add additional nursing orders to the plan.
• D. Collaborate with the healthcare provider to make changes.

Correct answer: B

Rationale: The correct first action for the LPN to take when a desired outcome is not achieved is to note which actions were not implemented. This step helps in identifying gaps in the plan of care and reasons for not achieving the desired outcome. Establishing a new nursing diagnosis (Choice A) is not the initial step when evaluating the plan of care. Adding additional nursing orders (Choice C) may not address the root cause of the unachieved outcome. Collaborating with the healthcare provider (Choice D) should come after identifying the gaps in the plan and reasons for the outcome not being met.

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