Nursing Elites

1. Which teaching point should the nurse include when providing education to an adolescent client who participates in soccer regarding the plan of care for diabetes mellitus?

• A. Decreased food intake
• B. Increased doses of insulin
• C. Increased food intake
• D. Decreased doses of insulin

Correct answer: C

Rationale: The correct teaching point the nurse should include is to advise the adolescent client who participates in soccer to increase food intake. Physical activity increases glucose utilization, so adolescents with diabetes need to consume additional carbohydrates to prevent hypoglycemia during and after exercise. Choice A (Decreased food intake) is incorrect because the adolescent needs extra carbohydrates to support the increased physical activity. Choice B (Increased doses of insulin) is incorrect as the focus should be on adjusting food intake rather than insulin doses. Choice D (Decreased doses of insulin) is also incorrect as the insulin doses should be adjusted based on the increased food intake and physical activity level.

2. Which congenital heart defect causes a "boot-shaped" heart on a chest x-ray?

• A. Tetralogy of Fallot
• B. Coarctation of the aorta
• C. Transposition of the great arteries
• D. Ventricular septal defect

Correct answer: A

Rationale: The correct answer is A: Tetralogy of Fallot. Tetralogy of Fallot, a congenital heart defect with four distinct abnormalities, often presents with a "boot-shaped" heart on chest x-ray due to right ventricular hypertrophy. This characteristic finding is due to the specific combination of defects in this condition. Coarctation of the aorta (choice B), Transposition of the great arteries (choice C), and Ventricular septal defect (choice D) do not typically result in a "boot-shaped" heart on a chest x-ray like Tetralogy of Fallot does.

3. What laboratory finding should the nurse expect in a child with an excess of water?

• A. Decreased hematocrit
• B. High serum osmolality
• C. High urine specific gravity
• D. Increased blood urea nitrogen (BUN)

Correct answer: A

Rationale: Water excess typically leads to hemodilution, resulting in a decreased hematocrit. High serum osmolality and specific gravity would indicate dehydration, while elevated BUN could suggest renal impairment or dehydration, not fluid overload.

4. A 4-month-old infant is discharged home after surgery for the repair of a cleft lip. What should instructions to the parents include?

• A. Provide crib toys for distraction
• B. Breast- or bottle-feeding can begin immediately
• C. Give pain medication to the infant to minimize crying
• D. Leave the infant in the crib at all times to prevent suture strain

Correct answer: C

Rationale: Pain management is essential postoperatively to reduce crying, which could place strain on the surgical site. Feeding and holding the infant are allowed, but care should be taken to avoid placing pressure on the suture line.

5. A 3-year-old child was adopted immediately after birth. The parents have just asked the nurse how they should tell the child that she is adopted. Which guideline concerning adoption should the nurse use in planning a response?

• A. It is best to wait until the child asks about it.
• B. The best time to tell the child is between the ages of 7 and 10 years.
• C. It is not necessary to tell a child who was adopted so young.
• D. Telling the child is an important aspect of their parental responsibilities.

Correct answer: D

Rationale: It is important to tell children about their adoption early, in an age-appropriate manner, as part of building trust and openness in the family relationship.

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