Nursing Elites

1. A 2-year-old child diagnosed with HIV comes to a clinic for immunizations. Which of the following vaccines should the healthcare provider expect to administer in addition to the scheduled vaccines?

• A. pneumococcal vaccine
• B. hepatitis A vaccine
• C. Lyme disease vaccine
• D. typhoid vaccine

Correct answer: A

Rationale: The correct answer is the pneumococcal vaccine. Children with HIV are at increased risk of pneumococcal infections, so the pneumococcal vaccine is recommended as a supplemental vaccine for them. The hepatitis A vaccine is not routinely given to HIV-positive children unless they have other risk factors for hepatitis A. Lyme disease vaccine is for individuals at risk for Lyme disease, not routinely recommended for a 2-year-old. Typhoid vaccine is typically given to individuals traveling to endemic areas or working in settings with potential exposure to Salmonella typhi, not a routine vaccine for a 2-year-old with HIV.

2. Following the change of shift report, when can or should the nurse's plan be altered or modified during the shift?

• A. halfway through the shift
• B. at the end of the shift before the nurse reports off
• C. when needs change
• D. after the top-priority tasks have been completed

Correct answer: C

Rationale: The correct answer is 'when needs change.' It is crucial for the nurse to remain adaptable and adjust the plan promptly when the patient's needs or condition change. Choice A, 'halfway through the shift,' may not align with the timing of when needs actually change, making it less optimal for plan modifications. Choice B, 'at the end of the shift before the nurse reports off,' is too late to address evolving needs effectively. Choice D, 'after the top-priority tasks have been completed,' limits the nurse's ability to respond promptly to changing priorities, as needs may shift before all top-priority tasks are finished.

3. Which of the following methods of contraception is able to reduce the transmission of HIV and other STDs?

• A. intrauterine device (IUD)
• B. Norplant
• C. oral contraceptives
• D. vaginal sponge

Correct answer: D

Rationale: The correct answer is the vaginal sponge. The vaginal sponge, when used with foam or jelly contraception, acts as a barrier method that can reduce the transmission of HIV and other STDs, in addition to preventing pregnancy. In contrast, IUDs, Norplant, and oral contraceptives are effective in preventing pregnancy but do not provide protection against the transmission of HIV and STDs. IUDs prevent pregnancy by affecting sperm movement and survival, Norplant releases hormones to prevent ovulation, and oral contraceptives work by inhibiting ovulation. However, these methods do not create a physical barrier against HIV and STD transmission. It is important to counsel clients using methods like IUDs, Norplant, and oral contraceptives to also use chemical or barrier contraceptives to lower the risk of HIV or STD transmission.

4. A healthcare provider is preparing to perform a Rinne test on a client who complains of hearing loss. In which area does the healthcare provider first place an activated tuning fork?

• A. On the client's teeth
• B. On the client's forehead
• C. On the client's mastoid bone
• D. On the midline of the client's skull

Correct answer: C

Rationale: In the Rinne test, the base of an activated tuning fork is held first against the mastoid bone, behind the ear, and then in front of the ear canal (0.5 to 2 inches). When the client no longer perceives the sound behind the ear, the fork is moved in front of the ear canal until the client indicates that the sound can no longer be heard. The client reports whether the sound from the tuning fork is louder behind the ear (on the mastoid bone) or in front of the ear canal. Placing the tuning fork on the teeth (Choice A), forehead (Choice B), or the midline of the skull (Choice D) is not part of the Rinne test procedure. Therefore, the correct answer is to first place the activated tuning fork on the client's mastoid bone.

5. When assisting the physician in performing transillumination of a client's scrotum, how should the nurse prepare for this procedure?

• A. Obtaining a flashlight and darkening the room
• B. Instructing the client to drink three glasses of water
• C. Instructing the client to take several deep breaths and bear down
• D. Telling the client that the procedure is very uncomfortable but that the discomfort will only last for a few moments

Correct answer: A

Rationale: When preparing for transillumination of the scrotum, the nurse should obtain a flashlight and darken the room. This is done to allow the strong flashlight to be shined from behind the scrotal contents. Normal scrotal contents do not appear on transillumination. Instructing the client to drink fluids or to take deep breaths and bear down is not part of the preparation for this procedure. Additionally, it is not necessary to inform the client that the procedure is uncomfortable as transillumination is a painless procedure.

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