Nursing Elites

1. A client is admitted for COPD. Which finding would require the nurse's immediate attention?

• A. Nausea and vomiting
• B. Restlessness and confusion
• C. Low-grade fever and cough
• D. Irritating cough and liquefied sputum

Correct answer: B

Rationale: Restlessness and confusion are signs of hypoxia and hypercapnia in a client with COPD, indicating that the client's condition may be deteriorating rapidly. Immediate attention is necessary to prevent further complications. Nausea and vomiting (Choice A) may be related to various factors but do not directly indicate respiratory distress. Low-grade fever and cough (Choice C) are common in COPD and may not require immediate intervention. Irritating cough and liquefied sputum (Choice D) are typical symptoms of COPD exacerbation but do not signal an immediate need for attention as restlessness and confusion.

2. The RN is planning care at a team meeting for a 2-month-old child in bilateral leg casts for congenital clubfoot. Which of these suggestions by the PN should be considered the priority nursing goal following cast application?

• A. Infant will experience minimal pain
• B. Muscle spasms will be relieved
• C. Mobility will be managed as tolerated
• D. Tissue perfusion will be maintained

Correct answer: D

Rationale: Following cast application for congenital clubfoot in a 2-month-old child, the priority nursing goal should be to maintain tissue perfusion. This is crucial to prevent complications like compartment syndrome and ensure proper healing. While managing pain, relieving muscle spasms, and promoting mobility are important aspects of care, they are secondary to ensuring adequate tissue perfusion in this scenario.

3. Which of the following activities is an example of tertiary prevention?

• A. Health education
• B. Regular exercise
• C. Screening tests
• D. Physical therapy

Correct answer: D

Rationale: The correct answer is D, physical therapy. Tertiary prevention focuses on rehabilitation and treatment to prevent complications from a disease or injury. Physical therapy falls under this category as it helps individuals recover and improve functionality after an illness or injury. Choices A, B, and C are not examples of tertiary prevention. Health education (choice A) is more aligned with primary prevention by promoting healthy behaviors to prevent disease onset. Regular exercise (choice B) can be categorized under both primary and secondary prevention as it aims to prevent disease development and detect conditions early. Screening tests (choice C) are part of secondary prevention as they aim to detect diseases at an early stage for prompt treatment.

4. True or False: Vertical transmission is the disease-causing agent (pathogen) from mother to baby during the period immediately before and after birth.

• A. TRUE
• B. FALSE
• C.
• D.

Correct answer: A

Rationale: Vertical transmission is the transfer of a disease-causing agent (pathogen) from mother to baby during the period immediately before and after birth. This process can lead to the baby acquiring infections or diseases from the mother. Choice A is correct because it accurately describes vertical transmission. Choices B, C, and D are incorrect as they do not reflect the definition of vertical transmission.

5. A child is diagnosed with poison ivy. The mother tells the nurse that she does not know how her child contracted the rash since he had not been playing in wooded areas. As the nurse asks questions about possible contact, which of the following would the nurse recognize as highest risk for exposure?

• A. Playing with toys in a backyard flower garden
• B. Eating small amounts of grass while playing 'farm'
• C. Playing with cars on the pavement near burning leaves
• D. Throwing a ball to a neighborhood child who has poison ivy

Correct answer: C

Rationale: The correct answer is C. Poison ivy can be contracted through smoke from burning plants, which can carry the urushiol oil that causes the rash. Playing near burning leaves would be the highest risk for exposure in this scenario. Choices A, B, and D do not involve direct contact with burning plants or leaves, making them lower-risk activities for exposure to poison ivy.

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