Nursing Elites

1. A patient is being treated in the Neurology Unit for Meningitis. Which of these is a priority assessment for the nurse to make?

• A. Assess the patient for nuchal rigidity
• B. Determine the patient's past exposure to infectious organisms
• C. Check the patient's WBC lab values
• D. Monitor for increased lethargy and drowsiness

Correct answer: D

Rationale: Monitoring for increased lethargy and drowsiness is crucial as these symptoms indicate a decreased level of consciousness, which is the cardinal sign of increased Intracranial Pressure (ICP). Elevated ICP can lead to serious complications and requires immediate intervention. Assessing for nuchal rigidity is important in suspected cases of meningitis but monitoring lethargy and drowsiness takes precedence due to its direct correlation with ICP. Determining past exposure to infectious organisms and checking WBC lab values are important for diagnosing and treating meningitis but do not directly address the immediate concern of increased ICP.

2. The nurse is caring for a client in the late stages of Amyotrophic Lateral Sclerosis (A.L.S.). Which finding would the nurse expect?

• A. Confusion
• B. Loss of half of the visual field
• C. Shallow respirations
• D. Tonic-clonic seizures

Correct answer: C

Rationale: In the late stages of Amyotrophic Lateral Sclerosis (A.L.S.), respiratory muscles are affected, leading to shallow respirations. Confusion is not typically associated with A.L.S. Loss of half of the visual field suggests a neurological issue unrelated to A.L.S., while tonic-clonic seizures are not commonly seen in A.L.S. patients. Shallow respirations are a hallmark sign of respiratory muscle weakness in A.L.S. due to the degeneration of motor neurons.

3. The nurse is planning discharge instructions for the mother of a child following orchiopexy, which was performed on an outpatient basis. Which is a priority in the plan of care?

• A. Wound care
• B. Pain control measures
• C. Measurement of intake
• D. Cold and heat applications

Correct answer: A

Rationale: Following orchiopexy, the priority in the plan of care for the child's mother is wound care. The most common complications associated with orchiopexy are bleeding and infection. Discharge instructions should focus on demonstrating wound cleansing and dressing, and teaching parents to recognize signs of infection like redness, warmth, swelling, or discharge. It is crucial to prevent movement of the testicles and avoid contamination of the suture line. While analgesics may be prescribed, pain control measures are not the priority among the options presented. Measurement of intake is not essential as the child is likely to resume normal eating habits. Cold and heat applications are not typical prescribed treatments for post-orchiopexy care.

4. The patient with idiopathic pulmonary arterial hypertension (IPAH) is receiving epoprostenol (Flolan). Which assessment information requires the most immediate action by the nurse?

• A. The oxygen saturation is 94%.
• B. The blood pressure is 98/56 mm Hg.
• C. The patient's central IV line is disconnected.
• D. The international normalized ratio (INR) is prolonged.

Correct answer: C

Rationale: The most immediate action required by the nurse is to address the disconnected central IV line delivering epoprostenol (Flolan). Epoprostenol has a short half-life of 6 minutes, necessitating immediate reconnection to prevent rapid clinical deterioration. While oxygen saturation, blood pressure, and INR are important parameters requiring monitoring and intervention, the priority lies in ensuring the continuous delivery of the critical medication to stabilize the patient's condition.

5. Which individual is at greatest risk for developing hypertension?

• A. 45-year-old African-American attorney
• B. 60-year-old Asian-American shop owner
• C. 40-year-old Caucasian nurse
• D. 55-year-old Hispanic teacher

Correct answer: A

Rationale: African-Americans have a higher risk of developing hypertension compared to other ethnic groups. They tend to develop high blood pressure at younger ages and are more sensitive to salt, which increases their risk of hypertension. Additionally, studies have shown that African-Americans may respond differently to hypertensive drugs. Therefore, the 45-year-old African-American attorney is at the greatest risk for developing hypertension. The other choices do not specify factors that put them at a higher risk for hypertension compared to African-Americans.

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