Nursing Elites

1. A 55-year-old patient admitted with an abrupt onset of jaundice and nausea has abnormal liver function studies, but serologic testing is negative for viral causes of hepatitis. Which question by the nurse is most appropriate?

• A. Is there any history of IV drug use?
• B. Do you use any over-the-counter drugs?
• C. Are you taking corticosteroids for any reason?
• D. Have you recently traveled to a foreign country?

Correct answer: B

Rationale: The most appropriate question for the nurse to ask in this scenario is whether the patient uses any over-the-counter drugs. The patient's symptoms, negative serologic testing for viral hepatitis, and sudden onset of symptoms point towards toxic hepatitis, which can be triggered by commonly used over-the-counter medications like acetaminophen (Tylenol). Asking about IV drug use is relevant for viral hepatitis, not toxic hepatitis. Inquiring about recent travel to a foreign country is more pertinent to potential exposure to infectious agents causing viral hepatitis. Corticosteroid use is not typically associated with the symptoms described in the case.

2. You have accompanied the physician into the family waiting room to tell a young husband that his wife has not survived the car accident she was in. The husband is crying and distraught. What is the most appropriate approach to supporting this family member?

• A. Ask if he would like to donate his wife's organs
• B. Sit quietly with him
• C. Ask about funeral arrangements
• D. Consult social services

Correct answer: B

Rationale: The most caring and supportive approach in a time of extreme distress is usually to sit quietly with the distressed individual until they have had the opportunity to absorb the news and gather themselves. Providing a supportive presence is often the most valuable tool a caregiver can use when circumstances bring overwhelming emotional pain to those they are caring for. Asking about organ donation at this moment may come off as insensitive and should not be a priority. Inquiring about funeral arrangements and consulting social services can be addressed later, once the husband has had time to process the initial shock and emotions.

3. What intervention should the nurse implement while a client is having a grand mal seizure?

• A. Open the jaw and place a bite block between the teeth
• B. Try to place the client on his side
• C. Restrain the client to prevent injury
• D. Place pillows around the client

Correct answer: B

Rationale: During a grand mal seizure, the client is at risk of injury due to severe, involuntary muscle spasms and contractions. It is crucial for the nurse to avoid restraining the client or inserting objects into their mouth, as these actions may lead to further harm. Placing the client on their side can help facilitate the drainage of oral secretions and assist in maintaining an open airway, reducing the risk of aspiration. Restraint should be avoided as it can exacerbate muscle contractions and increase the risk of injury. Placing pillows around the client may not provide adequate support or protection during the seizure, making it a less effective intervention compared to positioning the client on their side.

4. In children suspected to have a diagnosis of diabetes, which one of the following complaints would be most likely to prompt parents to take their school-age child for evaluation?

• A. Polyphagia
• B. Dehydration
• C. Bedwetting
• D. Weight loss

Correct answer: C

Rationale: The correct answer is 'Bedwetting.' One of the initial symptoms of type 1 diabetes in children is bedwetting. Parents are likely to notice bedwetting in a school-age child, prompting them to seek evaluation. Polyphagia (excessive hunger) and weight loss are also common symptoms of diabetes but may not be as readily noticeable to parents compared to bedwetting. Dehydration is a consequence of diabetes rather than an early symptom that would prompt parents for evaluation.

5. The nurse is caring for a 27-year-old female client with a venous stasis ulcer. Which nursing intervention would be most effective in promoting healing?

• A. Apply dressing using sterile technique
• B. Improve the client's nutrition status
• C. Initiate limb compression therapy
• D. Begin proteolytic debridement

Correct answer: B

Rationale: Venous stasis occurs when venous blood collects and stagnates in the lower leg due to incompetent venous valves. This leads to inadequate oxygen and nutrient supply to the cells in the lower extremities, resulting in cell death or necrosis. Venous stasis ulcers, characterized by shallow brown wounds with irregular margins, typically develop on the lower leg or ankle. The primary goal in managing clients with venous stasis ulcers is to promote healing. Proper nutrition plays a crucial role in wound healing. Nutritional deficiencies are common causes of venous ulcers, and a diet rich in protein, iron, zinc, and vitamins C and A is recommended to enhance wound healing. Applying dressings with sterile technique, initiating limb compression therapy, and beginning proteolytic debridement are important interventions in wound care but may not directly address the underlying issue of poor nutrition that is essential for healing venous stasis ulcers.

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