Nursing Elites

1. A 45-year-old client with type I diabetes is in need of support services upon discharge from a skilled rehabilitation unit. Which of the following services is an example of a skilled support service?

• A. shopping for groceries
• B. house cleaning
• C. transportation to physician's visits
• D. medication instruction

Correct answer: D

Rationale: The correct answer is medication instruction. This is a skilled service that requires specialized knowledge and training to provide proper guidance on medication management for a client with type I diabetes. Grocery shopping, house cleaning, and transportation services are considered unskilled services as they are typically offered by volunteer or fee-for-service agencies and do not require specialized medical expertise. Medication instruction, on the other hand, involves educating the client on how to properly take medications, understand potential side effects, and manage their medication regimen effectively, which necessitates a high level of expertise and training.

2. A paraplegic client is in the hospital to be treated for an electrolyte imbalance. Which level of care is the client currently receiving?

• A. primary prevention
• B. secondary prevention
• C. tertiary prevention
• D. health promotion

Correct answer: B

Rationale: The correct answer is B: secondary prevention. The client is currently receiving secondary prevention care. Secondary prevention focuses on early detection of disease, prompt intervention, and health maintenance for clients experiencing health problems. In this case, the electrolyte imbalance is a health problem that requires treatment to prevent further complications. Choices A, C, and D are incorrect because primary prevention is focused on health promotion and specific protections against illness before it occurs, tertiary prevention is aimed at helping rehabilitate clients after the illness is diagnosed and treated, and health promotion is a broader concept that includes activities aimed at improving overall health and well-being rather than targeting a specific health problem like an electrolyte imbalance.

3. The client provides information to a pregnant client who is experiencing nausea and vomiting about measures to relieve the discomfort. Which statement by the mother indicates the need for further information?

• A. ''I should eat five or six small meals a day rather than three full meals.''
• B. ''I need to be sure not to drink liquids with my meals.''
• C. ''I should keep dry crackers at my bedside and eat them before I get out of bed in the morning.''
• D. ''I need to avoid eating fried or greasy foods.''

Correct answer: B

Rationale: To alleviate nausea and vomiting, the client should avoid drinking liquids with meals. The client should keep dry crackers at her bedside, avoid fried foods, and eat smaller meals. Additionally, the client should eat dry crackers every 2 hours to prevent an empty stomach and avoid spicy foods and foods with strong odors, such as onion and cabbage. The incorrect choices are: A) Eating five or six small meals a day instead of three full meals is a correct recommendation. C) Keeping dry crackers at her bedside and eating them before getting out of bed in the morning is a helpful suggestion. D) Avoiding fried or greasy foods is a valid advice to alleviate nausea and vomiting.

4. A community health nurse is providing information to a group of older clients about measures to decrease the risk of contracting influenza during peak flu season. The nurse should provide which information?

• A. Clients must stay at home and ask a neighbor or family member to run their errands.
• B. It is best to do grocery shopping and other errands early in the morning when crowds are smaller.
• C. Clients should wash their hands frequently and keep hands away from the face, especially during peak flu season.
• D. Drinking eight 8-oz glasses of fluid each day will reduce the risk of contracting influenza.

Correct answer: C

Rationale: During peak influenza season, older clients should take measures to reduce the risk of contracting the flu. The most effective preventive measure is frequent hand hygiene and refraining from touching the face, as this reduces the transmission of the flu virus. While it is advisable to avoid crowds, the direct action of hand hygiene is more impactful. Doing errands early in the morning when crowds are smaller is a good suggestion to reduce exposure but does not address the direct transmission through hands. Drinking enough fluid daily is important for overall health but does not directly reduce the risk of contracting influenza.

5. When obtaining a health history on a menopausal woman, which information should a nurse recognize as a contraindication for hormone replacement therapy?

• A. family history of stroke
• B. ovaries removed before age 45
• C. frequent hot flashes and/or night sweats
• D. unexplained vaginal bleeding

Correct answer: D

Rationale: When considering hormone replacement therapy for a menopausal woman, unexplained vaginal bleeding should be recognized as a contraindication. This is because it could be indicative of a serious underlying condition that needs investigation before initiating hormone therapy. A family history of stroke, by itself, is not a contraindication for hormone replacement therapy, unless the woman herself has a history of stroke or blood-clotting events. Ovaries removed before age 45 may actually increase the likelihood of needing hormone replacement therapy due to early menopause. Frequent hot flashes and night sweats, on the other hand, are symptoms that can be relieved by hormone replacement therapy, making them a potential indication rather than a contraindication.

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