Nursing Elites

1. A female sex worker enters a clinic for treatment of a sexually transmitted disease. This disease is the most prevalent STD in the United States. The nurse can anticipate that the woman has which of the following?

• A. herpes
• B. chlamydia
• C. gonorrhea
• D. syphilis

Correct answer: B

Rationale: The question describes a female sex worker seeking treatment for the most prevalent sexually transmitted disease in the United States. Chlamydia is the correct answer as it is the most common STD in the country according to epidemiological studies. While herpes (choice A) is common, it is not the most prevalent. Gonorrhea (choice C) and syphilis (choice D) are less prevalent compared to chlamydia, making them incorrect choices.

2. A client begins a regimen of chemotherapy. Her platelet count falls to 98,000. Which action is least likely to increase the risk of hemorrhage?

• A. Test all excreta for occult blood.
• B. Use a soft toothbrush or foam cleaner for oral hygiene.
• C. Implement reverse isolation.
• D. Avoid IM injections.

Correct answer: C

Rationale: The correct answer is to implement reverse isolation. Reverse isolation is a protective measure used to protect patients from infections, not to affect the risk of hemorrhage. Testing all excreta for occult blood (Choice A) is important to monitor for signs of internal bleeding. Using a soft toothbrush or foam cleaner for oral hygiene (Choice B) is recommended to prevent gum bleeding. Avoiding IM injections (Choice D) is crucial to reduce the risk of bleeding in a client with a low platelet count. Therefore, among the given options, implementing reverse isolation is the least likely to increase the risk of hemorrhage.

3. Why is it often necessary to draw a complete blood count and differential (CBC/differential) when a client is being treated with an antiepileptic drug (AED)?

• A. The hematocrit is adversely affected due to increased vascular volume.
• B. AEDs can lead to blood dyscrasia as a side effect.
• C. AEDs may cause aplastic anemia and megaloblastic anemia.
• D. Some AEDs induce white blood cell reduction.

Correct answer: B

Rationale: When a client is being treated with antiepileptic drugs (AEDs), it is essential to monitor for potential side effects on blood parameters. Some AEDs can lead to blood dyscrasia, which includes conditions like aplastic anemia and megaloblastic anemia. Therefore, drawing a complete blood count and differential helps in identifying these adverse effects early. Choices A, C, and D are incorrect because the primary concern when monitoring blood parameters in clients on AEDs is the risk of blood dyscrasia, not changes in hematocrit due to vascular volume, white blood cell reduction, or immune modulation.

4. A nurse suspects a patient is developing Bell's Palsy. The nurse wants to test the function of cranial nerve VII. Which of the following would be the most appropriate testing procedures?

• A. Test the taste sensation over the back of the tongue and activation of the facial muscles.
• B. Test the taste sensation over the front of the tongue and activation of the facial muscles.
• C. Test the sensation of the facial muscles and sensation of the back of the tongue.
• D. Test the sensation of the facial muscles and sensation of the front of the tongue.

Correct answer: B

Rationale: The facial nerve (VII) is responsible for motor function to the face and sensory function to the anterior two-thirds of the tongue. Therefore, to appropriately test the function of cranial nerve VII, the most appropriate testing procedures involve assessing the taste sensation over the front of the tongue (sensory) and activation of the facial muscles (motor). Option B, 'Test the taste sensation over the front of the tongue and activation of the facial muscles,' is the correct answer. Choices A, C, and D are incorrect because they do not involve the correct combination of sensory testing over the front of the tongue and motor activation of the facial muscles, which are key functions associated with cranial nerve VII.

5. After a client with an Automated Internal Cardiac Defibrillator (AICD) is successfully defibrillated for Ventricular Fibrillation (VF), what should the nurse do next?

• A. Go to the client to assess for signs and symptoms of decreased cardiac output.
• B. Call the physician to inform them of the VF episode for medication adjustments.
• C. Call the 'on-call' person in the cath lab to re-charge the ICD in case of a recurrence.
• D. Document the incident on the code report form and follow up regularly.

Correct answer: A

Rationale: After a client is successfully defibrillated, the immediate priority is to assess the client for signs and symptoms of decreased cardiac output, such as altered level of consciousness, chest pain, shortness of breath, or hypotension. This assessment is crucial to determine the effectiveness of the defibrillation and the client's current hemodynamic status. Calling the physician for medication adjustments without assessing the client first could delay essential interventions. Contacting the 'on-call' person in the cath lab to re-charge the ICD is not the initial action needed after successful defibrillation. Documenting the incident is important but should not take precedence over assessing the client's immediate condition.

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