HESI RN EXIT EXAM Better learning

A child recently treated for strep throat presents with gross hematuria, facial swelling, and elevated blood pressure. Laboratory tests reveal proteinuria and azotemia. Which condition should the nurse suspect? • Acute pyelonephritis. • Acute glomerular nephritis. • Nephrotic syndrome. • IgA nephropathy. b) Acute glomerular nephritis. Rationale Acute glomerulonephritis (GN) usually manifests after strept throat or other streptococcal infection. Typical signs of acute GN include gross hematuria, facial edema, hypertension, andproteinuria. A child who is recovering from surgery for removal of a Wilms tumor develops abdominal painand distension, absence of bowel sounds, and vomiting. Which complication should the nurse suspect? • Intestinal obstruction. • Abdominal peritonitis. • Pyloric stenosis. • Infectious gastritis. a) Intestinal obstruction. Rationale Surgical intervention for Wilms tumor involves removal of the tumor, which requires either a partial or radical nephrectomy. Small bowel obstruction is one of the most common postoperative complications following removal of a Wilms tumor. A child diagnosed with Wilms tumor is being treated with dactinomycin. What class of drug is this medication? • Mitotic inhibitor. • Antitumor antibiotic. • Corticosteroid. • Alkylating agent. b) Antitumor antibiotic. Rationale Dactinomycin, also known as actinomycin D, is an anti-tumor antibiotic used in the treatment ofa variety of cancers, including Wilms tumor. The nurse is reviewing medication education with a client who was prescribed triamcinolone(Dermasorb) for the treatment of eczema. Which statement by the client indicates the client misunderstands safe administration? • Apply to affected areas, avoiding contact with the eyes. • Continue to apply medication for a few days after area has cleared. • Cover weeping or denuded areas with an occlusive dressing after medication application. • Affected areas treated with the medication can burn easily with sunlight exposure. c) Cover weeping or denuded areas with an occlusive dressing after medication application. The nurse explains to a new staff member that the goals of the therapeutic milieu for eating disorder are designed to help a client establish more adaptive behavioral patterns and developnormal eating habits. The nurse is caring for a client who has a fiberglass long leg cast on the right leg. Which nursing actions should be implemented in the cast care of this client? SATA • Smelling the cast and feeling for the presence of hot spots on the cast. • Checking neurovascular status of the right exposed foot and toes every four hours. • Using a soft cotton-tipped 6-inch swab to help scratch beneath the cast. • Placing the nurse's finger in the client's cast while performing cast care. • Covering the perineal area of the cast with plastic before client uses the fracture bedpan. • Smelling the cast and feeling for the presence of hot spots on the cast. • Checking neurovascular status of the right exposed foot and toes every four hours.d) Placing the nurse's finger in the client's cast while performing cast care. e) Covering the perineal area of the cast with plastic before client uses the fracture bedpan. Rationale Cast care should include ensuring the cast is not too tight, by placing a finger between the client'sskin and cast; by protecting the cast from being soiled by placing a protective plastic covering in the perineal area before the client uses a bedpan; by smelling for a foul odor coming from the cast; by palpating for hot spots on the cast every shift; and by performing neurovascular checks distal to the cast every four hours. Nothing should be placed in the cast to facilitate scratching beneath the cast.