Nursing Elites

1. What is an appropriate intervention for the edematous child with reduced mobility related to nephrotic syndrome?

• A. Assist the child in minimizing body movements.
• B. Change the child's position frequently.
• C. Maintain the child's bed flat.
• D. Keep edematous areas moist and covered.

Correct answer: B

Rationale: Changing the child's position frequently is essential for preventing respiratory tract infections and reducing pressure on delicate skin, which are common risks for edematous children with reduced mobility due to nephrotic syndrome. This intervention helps promote circulation and prevents complications associated with prolonged immobility.

2. The nurse is planning care for a school-age client who is postoperative for the surgical removal of the appendix. In addition to pharmacologic pain management, what should the nurse include in the plan of care to address pain?

• A. Applying a warm, moist pack every 4 hours
• B. Applying EMLA cream to the incision site prior to ambulation
• C. Applying a cold, moist pack every 2 hours
• D. Applying a pillow against the abdomen to splint the incision site when coughing

Correct answer: D

Rationale: After an appendectomy, applying a pillow against the abdomen to splint the incision site when coughing helps reduce pain by providing support and minimizing movement that could cause discomfort.

3. Which of the following is not considered a part of body language?

• A. Mannerisms
• B. Speech
• C. Posture
• D. Position

Correct answer: B

Rationale: Body language encompasses non-verbal communication cues such as mannerisms, posture, and position. Speech, although a form of communication, is not typically classified as part of body language. Body language mainly refers to gestures, facial expressions, and body movements, which convey messages non-verbally.

4. The healthcare provider is caring for a child on bed rest who has severe edema in the left lower extremity due to blocked lymphatic drainage. Which nursing diagnosis would take priority?

• A. Risk for Impaired Skin Integrity
• B. Risk for Altered Body Image
• C. Risk for Imbalanced Nutrition: Less Than Body Requirements
• D. Risk for Activity Intolerance

Correct answer: A

Rationale: The priority nursing diagnosis in this scenario is 'Risk for Impaired Skin Integrity' because severe edema in the left lower extremity can lead to compromised circulation and pressure ulcers, increasing the risk of skin breakdown and infection. Addressing and preventing impaired skin integrity is crucial for the child's overall health and well-being.

5. An 80-year-old patient with a history of renal insufficiency was recently started on cimetidine. Which assessment finding indicates that the patient may be experiencing an adverse effect of the medication?

• A. Pain with urination
• B. New onset disorientation to time and place
• C. HR changes from a baseline of 70-80bpm to 110-120bpm
• D. #ERROR!

Correct answer: B

Rationale: The correct answer is B: New onset disorientation to time and place. Cimetidine can cause adverse effects on the CNS system, especially in elderly patients with renal or hepatic impairment. This may manifest as confusion, hallucinations, lethargy, restlessness, or seizures. Pain with urination (choice A) is not typically associated with cimetidine use, and HR changes (choice C) are more likely related to other factors. Choice D is not a valid option.

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