Nursing Elites

1. When assessing the respiratory system of an older patient, which finding indicates that the nurse should take immediate action?

• A. Weak cough effort
• B. Barrel-shaped chest
• C. Dry mucous membranes
• D. Bilateral crackles at lung bases

Correct answer: D

Rationale: Bilateral crackles at lung bases indicate a potential acute issue like heart failure. Immediate action is necessary in this situation. The nurse should conduct further assessments such as oxygen saturation and inform the healthcare provider promptly. A barrel-shaped chest and hyperresonance to percussion are typical signs of aging and do not require immediate action. A weak cough effort is common in older patients due to age-related changes, and dry mucous membranes are also expected in older individuals. While these findings may warrant further evaluation, they do not demand immediate action like bilateral crackles at lung bases.

2. When taking a patient’s history, she mentions being depressed and dealing with an anxiety disorder. Which of the following medications would the patient most likely be taking?

• A. Amitriptyline (Elavil)
• B. Calcitonin
• C. Pergolide mesylate (Permax)
• D. Verapamil (Calan)

Correct answer: A

Rationale: The correct answer is Amitriptyline (Elavil) as it is a tricyclic antidepressant commonly used to treat symptoms of depression and anxiety disorders. Amitriptyline works by increasing the levels of certain neurotransmitters in the brain to improve mood. Choices B, C, and D are incorrect. Calcitonin is a hormone used in the treatment of osteoporosis; Pergolide mesylate is a dopamine agonist used in Parkinson's disease; Verapamil is a calcium channel blocker used to treat high blood pressure and certain heart conditions, not mental health disorders.

3. A child is admitted to the hospital with a diagnosis of Wilms tumor, stage II. Which of the following statements most accurately describes this stage?

• A. The tumor is less than 3 cm in size and requires no chemotherapy.
• B. The tumor did not extend beyond the kidney and was completely resected.
• C. The tumor extended beyond the kidney but was completely resected.
• D. The tumor has spread into the abdominal cavity and cannot be resected.

Correct answer: C

Rationale: In Wilms tumor staging, stage II indicates that the tumor extends beyond the kidney but is completely resected. This means that the tumor has spread beyond the kidney but has been successfully removed. Choices A and B are incorrect because a tumor less than 3 cm in size and a tumor that did not extend beyond the kidney do not align with the characteristics of stage II Wilms tumor. Choice D is also incorrect as it describes a more advanced stage where the tumor has spread into the abdominal cavity and cannot be completely resected. Therefore, the correct answer is C, as it accurately reflects the characteristics of a stage II Wilms tumor.

4. Which of the following measures would be appropriate for a nurse to teach the parent of a nine-month-old infant about diaper dermatitis?

• A. Use only cloth diapers that are rinsed in bleach
• B. Do not use occlusive ointments on the rash
• C. Use commercial baby wipes with each diaper change
• D. Discontinue a new food that was added to the infant's diet just prior to the rash

Correct answer: D

Rationale: Diaper dermatitis can be caused by various factors, one of which includes introducing new foods to the infant's diet. Discontinuing the new food that was added just before the rash can help identify and eliminate the potential cause. Options A and C are not directly related to addressing the cause of diaper dermatitis. While using cloth diapers rinsed in bleach may be a preventive measure for diaper dermatitis, it is not addressing a specific cause. Option B, advising against using occlusive ointments on the rash, may actually be beneficial in managing diaper dermatitis, but it does not address the cause of the condition.

5. The nurse has just admitted a client with severe depression. From which focus should the nurse identify a priority nursing diagnosis?

• A. Nutrition
• B. Elimination
• C. Activity
• D. Safety

Correct answer: D

Rationale: In caring for a client with severe depression, safety is a critical priority. The nurse must address precautions to prevent suicide as part of the care plan. While nutrition, elimination, and activity are important aspects of care, safety takes precedence due to the immediate risk of harm associated with depression. Ensuring the client's safety by implementing measures to prevent self-harm or suicide is the priority intervention. Addressing nutrition, elimination, and activity can follow once the client's safety is assured.

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