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: The correct answer is D: Abdominal mass and weakness. In neuroblastoma, the most common presenting signs are related to the mass effect of the tumor, leading to an abdominal mass and symptoms of weakness. Lymphedema and nerve palsy (Choice A) are not typically associated with neuroblastoma. Hearing loss and ataxia (Choice B) are more indicative of other conditions like neurofibromatosis or brain tumors. Headaches and vomiting (Choice C) are more commonly seen in conditions such as brain tumors or increased intracranial pressure, but they are not specific to neuroblastoma.

2. During an assessment, a client receiving tube feedings via NG tube shows signs of nasal mucosa irritation. What finding should the nurse report to the provider?

• A. Potassium 5.5 mEq/L
• B. Irritation of nasal mucosa
• C. Sodium 144 mEq/L
• D. Loose stools

Correct answer: B

Rationale: Irritation of nasal mucosa is a crucial finding that the nurse should report to the provider as it suggests potential complications with NG tube placement, such as improper positioning or mucosal damage. High potassium levels (Choice A) can be concerning but are not directly related to NG tube placement issues. Normal sodium levels (Choice C) and loose stools (Choice D) are common occurrences in clients receiving tube feedings and are not typically indicative of immediate complications that require urgent reporting.

3. When responding to a call light and finding a client on the bathroom floor, what should the nurse do FIRST?

• A. Check the client for injuries
• B. Call for additional help
• C. Move the client to a sitting position
• D. Assist the client back to bed

Correct answer: A

Rationale: Checking the client for injuries is the priority when finding them on the bathroom floor. This action ensures the client's safety as it allows for immediate assessment of any potential harm. Calling for help may be necessary, but assessing for injuries takes precedence to address any immediate threats to the client's well-being. Moving the client to a sitting position or assisting them back to bed should only be done after ensuring there are no serious injuries requiring prompt medical attention. Therefore, the correct first action is to check the client for injuries.

4. A client is receiving a blood transfusion. The client reports flank pain, and the nurse notes reddish-brown urine in the client's urinary catheter bag. The nurse recognizes these manifestations as which of the following types of transfusion reactions?

• A. Hemolytic
• B. Allergic
• C. Febrile
• D. Transfusion-related acute lung injury (TRALI)

Correct answer: A

Rationale: The correct answer is A: Hemolytic. Hemolytic reactions can lead to flank pain and hemoglobinuria, as the body breaks down the transfused red blood cells. In hemolytic reactions, the immune system attacks and destroys the transfused red blood cells, causing the release of hemoglobin into the bloodstream and urine. This results in reddish-brown urine, indicating hemoglobinuria. Allergic reactions typically present with symptoms like itching, hives, or rash. Febrile reactions are characterized by fever, chills, and rigors. TRALI is a rare but serious transfusion reaction that manifests as acute respiratory distress following a transfusion, not flank pain and hemoglobinuria.

5. In a client with liver cirrhosis, which symptom would be most concerning during assessment?

• A. Jaundice
• B. Ascites
• C. Hepatomegaly
• D. Altered mental status

Correct answer: D

Rationale: Altered mental status would be the most concerning symptom in a client with liver cirrhosis. It may indicate hepatic encephalopathy, a serious complication requiring immediate intervention. While jaundice, ascites, and hepatomegaly are common in liver cirrhosis, they do not directly correlate with the urgency and severity of hepatic encephalopathy as altered mental status does. Therefore, altered mental status takes priority for immediate attention and intervention.

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