Nursing Elites

1. Which question should the nurse ask the parents of a child suspected of having glomerulonephritis?

• A. Did your child fall off a bike onto the handlebars?
• B. Has the child had persistent nausea and vomiting?
• C. Has the child been itching or had a rash anytime in the last week?
• D. Has the child had a sore throat or a throat infection in the last few weeks?

Correct answer: D

Rationale: Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Group A β-hemolytic streptococcal infection is a common cause of glomerulonephritis. Children with glomerulonephritis often develop symptoms after a throat infection caused by streptococcal bacteria. Therefore, asking about a sore throat or throat infection in the last few weeks is crucial to assess the possible link to glomerulonephritis. Choices A, B, and C are not directly associated with the pathophysiology of glomerulonephritis. Asking about falling off a bike, nausea and vomiting, or itching and rash do not provide relevant information for assessing glomerulonephritis in this context.

2. The nurse is caring for a newborn with a suspected diagnosis of imperforate anus. The nurse monitors the infant, knowing that which is a clinical manifestation associated with this disorder?

• A. Bile-stained fecal emesis
• B. The passage of currant jelly-like stools
• C. Failure to pass meconium stool in the first 24 hours after birth
• D. Sausage-shaped mass palpated in the upper right abdominal quadrant

Correct answer: C

Rationale: Imperforate anus is the incomplete development or absence of the anus in its normal position in the perineum. Failure to pass meconium stool within the first 24 hours after birth is a key clinical manifestation associated with this disorder. This finding should prompt further assessment to confirm the suspected diagnosis. Other assessment findings in imperforate anus may include absence or stenosis of the anal rectal canal, presence of an anal membrane, and an external fistula to the perineum. Options A, B, and D describe findings typically noted in intussusception, a different condition characterized by bowel obstruction and telescoping of the intestines that can present with bile-stained fecal emesis, the passage of currant jelly-like stools, and a sausage-shaped mass palpated in the upper right abdominal quadrant.

3. A patient with Meningitis is being treated with Vancomycin intravenously 3 times per day. The nurse notes that the urine output during the last 8 hours was 200mL. What is the nurse's priority action?

• A. Check the patient's last BUN levels
• B. Ask the patient to increase their fluid intake
• C. Ask the physician to order a diuretic
• D. Notify the physician of this finding

Correct answer: D

Rationale: Vancomycin is a nephrotoxic drug and can cause impaired renal perfusion, which would lead to decreased urine output. This is a serious adverse effect that should be promptly reported to the physician. Checking the patient's last BUN levels (Choice A) may provide additional information but does not address the urgency of the situation. Asking the patient to increase fluid intake (Choice B) may not be appropriate if the cause is related to Vancomycin toxicity. Ordering a diuretic (Choice C) without physician evaluation can exacerbate the issue, making notifying the physician (Choice D) the most critical action to take.

4. When orally administering alendronate (Fosamax), a bisphosphonate drug, to a largely bed-bound patient being treated for osteoporosis, what is the most important nursing consideration?

• A. Sit the head of the bed up for 30 minutes after administration
• B. Give the patient a small amount of water to drink
• C. Feed the patient soon, at most 10 minutes after administration
• D. Assess the patient for back pain or abdominal pain

Correct answer: A

Rationale: The correct nursing consideration when administering bisphosphonates like alendronate is to sit the head of the bed up for 30 minutes after administration. Bisphosphonates are known to cause esophageal irritation, which can lead to esophagitis. By sitting upright, the patient reduces the time the medication spends in the esophagus, decreasing the risk of irritation and potential adverse effects. Giving the patient water to drink or feeding them immediately after administration can increase the risk of esophageal irritation. Assessing the patient for back pain or abdominal pain is important but not the most critical consideration during drug administration.

5. A child is seen in the emergency department for scarlet fever. Which of the following descriptions of scarlet fever is not correct?

• A. Scarlet fever is caused by infection with group A Streptococcus bacteria.
• B. "Strawberry tongue"? is a characteristic sign.
• C. Petechiae occur on the soft palate.
• D. The pharynx is red and swollen.

Correct answer: C

Rationale: Petechiae on the soft palate are not a typical finding in scarlet fever. Scarlet fever is caused by group A Streptococcus bacteria, often presenting with a strawberry tongue, red and swollen pharynx, and a sandpaper-like rash. The presence of petechiae on the soft palate is more commonly associated with conditions like rubella rather than scarlet fever. Therefore, this description is not correct in the context of scarlet fever.

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