Nursing Elites

1. A nurse discharge planner is preparing a client for discharge from an acute care setting. The nurse assesses that skilled home care services are clinically indicated. This assessment is based on all of the following indicators except:

• A. the client has been admitted to the hospital three times in the last 2 months.
• B. the client has a Foley catheter.
• C. the client's family is available to care for him 24 hours a day.
• D. the client is ordered to continue IV antibiotics 5 days post discharge.

Correct answer: V

Rationale: Family availability to provide care and assistance is not an indicator for skilled home care services. In fact, the nurse might see an opportunity for family education to meet the client's needs so that less community support is needed. This should be discussed and negotiated with the family. Frequent hospital readmissions indicate that the client has not been able to manage either due to condition instability or lack of care needs being met, which is a red flag for home care services to monitor and meet those needs appropriately. A Foley catheter requires home health care due to infection potential and care requirements. IV antibiotics also necessitate home care for maintaining line patency and assessing the site.

2. A child comes to the clinic with a skin rash. The maculopapular lesions are distributed around the mouth and have honey-colored drainage. The caregiver states that the rash is getting worse and seems to spread with the child's scratching. Which of the following advisory comments should be given?

• A. The history and presentation might indicate chickenpox, a highly contagious disease.
• B. The lesions might indicate a noncontagious infection that does not require isolation.
• C. The history and presentation might indicate an infectious illness called impetigo.
• D. The lesions are not contagious unless others have open wounds or lesions themselves.

Correct answer: C

Rationale: The scenario describes classic impetigo, characterized by maculopapular lesions with honey-colored drainage, typically caused by Staphylococcus aureus or Streptococcus pyogenes. Antibiotic therapy is usually indicated for impetigo. Chickenpox, a highly contagious disease, presents with a history of high fever followed by a vesicular rash, different from the described maculopapular lesions with honey-colored drainage. Choice A is incorrect as the presentation is not consistent with chickenpox. Choice B is incorrect because impetigo is contagious, especially through direct contact. Choice D is also incorrect as impetigo is a contagious skin infection regardless of others having open wounds or lesions.

3. What spinal change occurring with pregnancy alters mobility?

• A. Scoliosis.
• B. Kyphosis.
• C. Lordosis.
• D. Ankylosing spondylitis.

Correct answer: C

Rationale: The correct answer is 'Lordosis.' During pregnancy, the enlarging uterus places increased weight on the spine, causing an exaggerated inward curvature known as lordosis. This change alters mobility by shifting the center of gravity forward, leading to a compensatory change in posture. Scoliosis (choice A) is a sideways curvature of the spine, not typically associated with pregnancy. Kyphosis (choice B) is an exaggerated outward curvature of the spine, while ankylosing spondylitis (choice D) is a chronic inflammatory condition affecting the spine, neither of which are directly related to the spinal changes seen in pregnancy.

4. A nurse in a long-term care center notes that an employee is constantly calling in sick. Which action should the nurse take initially to handle this problem?

• A. Documenting the employee's absences in the personnel file
• B. Discussing the situation with the employee and reminding them of the agency's employment standards
• C. Reporting the employee to administration
• D. Issuing a written warning to the employee

Correct answer: B

Rationale: When an employee demonstrates excessive absenteeism, the initial action a nurse should take is to discuss the situation with the employee and remind them of the agency's employment standards. It is important to communicate openly with the employee to understand the reasons for their frequent absences and remind them of the expectations regarding attendance. This approach allows for a constructive dialogue and provides the employee with an opportunity to rectify their behavior. Documenting the employee's absences in the personnel file may be necessary if the issue persists despite the discussion. Reporting the employee to administration should be considered only if the employee fails to improve after the initial discussion. Issuing a written warning should be a subsequent step if the employee continues to violate the attendance policies even after reminders and discussions.

5. A client asks a nurse about the procedure for becoming an organ donor. The nurse provides the client with which information?

• A. To speak with the chaplain about the psychosocial aspects of becoming a donor
• B. That this decision must be made by the next of kin at the time of the client's death
• C. That anatomic gifts must be made in writing and signed by the client
• D. To let the health care provider know about the request so that it may be documented in the client's record

Correct answer: C

Rationale: When a person wishes to become an organ donor, they need to understand that anatomic gifts must be made in writing and signed by the individual. The gift must be made by the donor themselves, typically an individual who is at least 18 years old. If the client is unable to sign, the document should be signed by another person and two witnesses. While speaking to a chaplain or informing the healthcare provider may be part of the process, the essential step is to have a written document signed by the client. Choice A is incorrect as it does not address the procedural aspect of becoming an organ donor. Choice B is incorrect as the decision to make an anatomic gift is typically made by the individual themselves, not the next of kin. Choice D is incorrect as simply informing the healthcare provider is not sufficient for the procedure of becoming an organ donor; a written and signed document by the client is necessary.

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