Nursing Elites

1. In which type of cancer are the urinary excretion of the breakdown products of catecholamines, especially vanillylmandelic acid (VMA) and homovanillic acid (HVA), detected?

• A. Neuroblastoma
• B. Nephroblastoma
• C. Leukemia
• D. Osteosarcoma

Correct answer: A

Rationale: The correct answer is A: Neuroblastoma. Neuroblastoma, a cancer that arises from nerve tissue, is associated with increased levels of catecholamine metabolites, including VMA and HVA, in the urine. Nephroblastoma (Wilms tumor) is a type of kidney cancer and is not typically associated with elevated levels of catecholamine breakdown products. Leukemia is a cancer of the blood and bone marrow and does not lead to increased VMA and HVA excretion in urine. Osteosarcoma is a bone cancer and is not linked to elevated levels of catecholamine metabolites in the urine.

2. The nurse is evaluating research studies according to the GRADE criteria and has determined the quality of evidence on the subject is moderate. Which type of evidence does this determination indicate?

• A. Strong evidence from unbiased observational studies
• B. Evidence from randomized clinical trials showed inconsistent results
• C. Consistent evidence from well-performed randomized clinical trials
• D. Evidence for at least one critical outcome from randomized clinical trials had serious flaws

Correct answer: B

Rationale: Moderate evidence typically indicates that results from randomized clinical trials were inconsistent, highlighting the need for further research to confirm findings.

3. What is a priority intervention for an infant with a temporary colostomy for Hirschsprung disease?

• A. Teaching how to irrigate the colostomy
• B. Protecting the skin around the colostomy
• C. Discussing the implications of a colostomy during puberty
• D. Using simple, straightforward language to prepare the child

Correct answer: B

Rationale: Protecting the skin around the colostomy is crucial to prevent irritation and infection, which are common complications in infants with colostomies. Teaching and discussing long-term implications are important but secondary to immediate skin care needs.

4. A child has been diagnosed with a Wilms tumor. What should preoperative nursing care include?

• A. Careful bathing and handling
• B. Monitoring of behavioral status
• C. Maintenance of strict isolation
• D. Administration of packed red blood cells

Correct answer: A

Rationale: The correct answer is A: Careful bathing and handling. Preoperative care for a child with a Wilms tumor should focus on preventing any trauma to the abdomen, which could lead to tumor rupture. Monitoring behavioral status and maintaining strict isolation are not as critical in this situation. Behavioral status is important but not a priority in preoperative care for a Wilms tumor. Strict isolation is not necessary unless there are specific infectious concerns, which is not typically the case for a Wilms tumor. Administration of packed red blood cells is not a standard preoperative intervention for Wilms tumor.

5. When teaching a mother how to administer eye drops, where should the nurse tell her to place them?

• A. At the lacrimal duct
• B. On the sclera while the child looks to the outside
• C. In the conjunctival sac when the lower eyelid is pulled down
• D. Carefully under the eyelid while it is gently pulled upward

Correct answer: C

Rationale: Eye drops should be placed in the conjunctival sac, which allows the medication to be absorbed properly without causing irritation. Placing drops directly on the sclera or near the lacrimal duct is less effective and can cause discomfort.

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