Nursing Elites

1. 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.

2. A patient's nursing diagnosis is Insomnia. The desired outcome is: "Patient will sleep for a minimum of 5 hours nightly by October 31."? On November 1, a review of the sleep data shows the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. What is the nurse's next action?

• A. Continue the current plan without changes.
• B. Remove this nursing diagnosis from the plan of care.
• C. Write a new nursing diagnosis that better reflects the problem.
• D. Revise the target date for outcome attainment and examine interventions.

Correct answer: D

Rationale: The correct action for the nurse in this scenario is to revise the target date for outcome attainment and reevaluate interventions. The initial desired outcome was for the patient to sleep for a minimum of 5 hours nightly by October 31. Since the patient is currently sleeping an average of 4 hours nightly and taking a 2-hour afternoon nap, the goal has not been achieved. By extending the time frame for attaining the outcome, the patient may have more time to progress towards the desired sleep duration. Additionally, examining interventions is crucial to identify any changes or adjustments that may be necessary to help the patient achieve the desired outcome. Continuing the current plan without changes is not appropriate as the goal has not been met. Removing the nursing diagnosis from the plan of care should only be considered when the problem is resolved. Writing a new nursing diagnosis is not needed as the current diagnosis of Insomnia still accurately reflects the patient's condition.

3. A child has just been diagnosed with juvenile idiopathic arthritis. Which of the following statements about the disease is most accurate?

• A. The child has a poor chance of recovery without joint deformity.
• B. Most children progress to adult rheumatoid arthritis.
• C. Nonsteroidal anti-inflammatory drugs are the first choice in treatment.
• D. Physical activity should be minimized.

Correct answer: C

Rationale: The correct answer is that nonsteroidal anti-inflammatory drugs are the first choice in treatment for juvenile idiopathic arthritis (formerly known as juvenile rheumatoid arthritis). NSAIDs are important as a first-line treatment and typically require 3-4 weeks for the therapeutic anti-inflammatory effects to be realized. Choice A is incorrect as early treatment can improve outcomes and prevent joint deformities. Choice B is incorrect as juvenile idiopathic arthritis does not necessarily progress to adult rheumatoid arthritis. Choice D is incorrect as physical activity should be encouraged in children with arthritis to maintain joint mobility and overall health.

4. Which laboratory test result should the nurse monitor to evaluate the effects of therapy for a 62-year-old female patient with acute pancreatitis?

• A. Calcium
• B. Bilirubin
• C. Amylase
• D. Potassium

Correct answer: C

Rationale: The correct answer is C: Amylase. In acute pancreatitis, amylase levels are typically elevated. Monitoring amylase levels helps assess the effectiveness of therapy in managing the condition. Elevated amylase is a key indicator of pancreatic inflammation. Calcium (Choice A) levels may be affected in pancreatitis, but they are not the primary indicator for evaluating therapy effectiveness. Bilirubin (Choice B) and Potassium (Choice D) levels may also be altered in pancreatitis, but they are not specific markers for monitoring therapy response in acute pancreatitis.

5. A nurse is caring for a patient admitted to the emergency room for an ischemic stroke with marked functional deficits. The physician is considering the use of fibrinolytic therapy with TPA (tissue plasminogen activator). Which history-gathering question would not be important for the nurse to ask?

• A. What time did you first notice symptoms consistently appearing?
• B. Have you been taking any blood thinners such as heparin, lovenox, or warfarin?
• C. Have you had another stroke or head trauma in the previous 3 months?
• D. Have you had any blood transfusions within the previous year?

Correct answer: D

Rationale: The correct answer is 'Have you had any blood transfusions within the previous year?' This question is not relevant in the context of considering fibrinolytic therapy with TPA for an ischemic stroke. Blood transfusions within the previous year do not directly impact the decision to use TPA in the treatment of an acute ischemic stroke. The focus should be on factors such as the time of symptom onset, current medications like blood thinners, and recent history of strokes or head trauma, as these are more directly related to the decision-making process for administering TPA in this emergency situation.

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