Nursing Elites

1. A patient has acute bronchitis with a nonproductive cough and wheezes. Which topic should the nurse plan to include in the teaching plan?

• A. Purpose of antibiotic therapy
• B. Ways to limit oral fluid intake
• C. Appropriate use of cough suppressants
• D. Safety concerns with home oxygen therapy

Correct answer: C

Rationale: In acute bronchitis, which is often viral, cough suppressants can help manage the symptoms of a nonproductive cough. Antibiotics are not typically used in acute bronchitis unless there are systemic symptoms indicating a bacterial infection. Limiting oral fluid intake is not recommended; in fact, maintaining adequate hydration is important. Safety concerns with home oxygen therapy may not be directly relevant to the management of acute bronchitis.

2. A child diagnosed with Hepatitis A is under the care of a healthcare provider. Which of the following precautions would be most important to take to prevent the transmission of this infectious disease?

• A. Encourage the Hepatitis A vaccine for family members and siblings
• B. Use needleless systems if possible; otherwise, use careful needle precautionary measures
• C. Teach the child and enforce strict and frequent hand washing
• D. Teach the child and family about the dangers of contaminated food and water

Correct answer: C

Rationale: The most crucial precaution to prevent the transmission of Hepatitis A is to emphasize strict and frequent hand washing. Hepatitis A is a virus that spreads through the oral-fecal route and can survive on human hands. Hand washing is the most effective measure to reduce the risk of transmission. Encouraging the Hepatitis A vaccine for family members and siblings (Choice A) is beneficial for prevention but not as directly impactful as hand washing. While needle precautions (Choice B) are important in healthcare settings, they are not directly relevant to preventing the spread of Hepatitis A. Teaching about the dangers of contaminated food and water (Choice D) is important for general hygiene but may not be as effective as emphasizing hand hygiene in preventing the spread of Hepatitis A.

3. The nurse palpates the posterior chest while the patient says 99 and notes absent fremitus. What action should the nurse take next?

• A. Auscultate anterior and posterior breath sounds bilaterally
• B. Encourage the patient to turn, cough, and deep breathe
• C. Review the chest x-ray report for evidence of pneumonia
• D. Palpate the anterior chest and observe for barrel chest

Correct answer: A

Rationale: To assess for tactile fremitus, the nurse should use the palms of the hands to assess for vibration when the patient repeats a word or phrase such as '99'. After noting absent fremitus, the nurse should then auscultate the lungs to assess for the presence or absence of breath sounds. Absent fremitus may be noted with conditions like pneumothorax or atelectasis. The vibration is increased in conditions such as pneumonia, lung tumors, thick bronchial secretions, and pleural effusion. Encouraging the patient to turn, cough, and deep breathe is an appropriate intervention for atelectasis, but assessing breath sounds takes priority. Fremitus is decreased if the hand is farther from the lung or the lung is hyperinflated (barrel chest). Palpating the anterior chest for fremitus is less effective due to the presence of large muscles and breast tissue, making auscultation a more appropriate next step.

4. Which playroom activities should the nurse organize for a small group of 7-year-old hospitalized children?

• A. Sports and games with rules
• B. Finger paints and water play
• C. Dress-up clothes and props
• D. Chess and television programs

Correct answer: A

Rationale: The correct answer is 'Sports and games with rules.' For 7-year-old children, organized activities that involve rules are beneficial as they promote cooperation, logical reasoning, and the development of social skills. Sports and games with rules help children understand the importance of following guidelines, playing fairly, and working together towards a common goal. Finger paints and water play (choice B) may be more suitable for younger children and may not fully engage 7-year-olds in the same way that structured games would. Dress-up clothes and props (choice C) primarily encourage imaginative play but may not emphasize the same level of cooperation and rule-following as sports and games. Chess and television programs (choice D) may not be as interactive or physically engaging as sports and games, limiting the opportunities for social interaction and cooperation among the children.

5. An 85-year-old male has been losing mobility and gaining weight over the last two months. The patient also has the heater running in his house 24 hours a day, even on warm days. Which of the following tests is most likely to be performed?

• A. CBC (complete blood count)
• B. ECG (electrocardiogram)
• C. Thyroid function tests
• D. CT scan

Correct answer: C

Rationale: The symptoms of weight gain and poor temperature tolerance in an elderly male suggest a potential thyroid dysfunction. Thyroid function tests are crucial in differentiating between hyperthyroidism, hypothyroidism, and a euthyroid state. These tests involve measuring the serum levels of thyroid hormones T3 and T4, also known as thyroxine, to evaluate thyroid function accurately. A complete blood count (Choice A) would not directly address the symptoms presented. An electrocardiogram (Choice B) assesses heart activity and would not be the primary test for these symptoms. A CT scan (Choice D) provides detailed images of internal organs and structures, which would not be the initial investigation for the described symptoms.

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