Nursing Elites

1. A patient with acute shortness of breath is admitted to the hospital. Which action should the nurse take during the initial assessment of the patient?

• A. Ask the patient to lie down to complete a full physical assessment.
• B. Briefly ask specific questions about this episode of respiratory distress.
• C. Complete the admission database to check for allergies before treatment.
• D. Delay the physical assessment to first complete pulmonary function tests.

Correct answer: B

Rationale: When a patient presents with acute shortness of breath, the initial assessment should focus on gathering specific information relevant to the current episode of respiratory distress. A comprehensive health history or full physical examination can be deferred until the acute distress has been addressed. Asking specific questions helps determine the cause of the distress and guides appropriate treatment. While checking for allergies is important, completing the entire admission database is not a priority during the initial assessment. Likewise, delaying the physical assessment for pulmonary function tests is not recommended as the immediate focus should be on addressing the acute respiratory distress before ordering further diagnostic tests or interventions.

2. The patient who has two fractured ribs from an automobile accident is receiving discharge teaching. Which statement by the patient indicates effective teaching?

• A. I am going to buy a rib binder to wear during the day.
• B. I can take shallow breaths to prevent my chest from hurting.
• C. I should plan on taking the pain pills only at bedtime so I can sleep.
• D. I will use the incentive spirometer every hour or two during the day.

Correct answer: D

Rationale: The correct answer is, 'I will use the incentive spirometer every hour or two during the day.' After sustaining rib fractures, it is crucial to prevent complications like atelectasis and pneumonia by practicing deep breathing and coughing. Using the incentive spirometer helps in maintaining lung expansion and preventing respiratory issues. Buying a rib binder could restrict chest expansion and hinder deep breathing efforts, increasing the risk of atelectasis. Taking shallow breaths may not effectively expand the lungs, leading to potential respiratory complications. Relying solely on pain medication at bedtime may not adequately address the need for lung expansion and prevention of respiratory complications during the day.

3. The nurse is caring for clients in the pediatric unit. A 6-year-old patient is admitted with 2nd and 3rd degree burns on his arms. The nurse should assign the new patient to which of the following roommates?

• A. A 4-year-old with sickle-cell disease
• B. A 12-year-old with chickenpox
• C. A 6-year-old undergoing chemotherapy
• D. A 7-year-old with a high temperature

Correct answer: A

Rationale: The nurse should be concerned about the burn patient's vulnerability to infection due to compromised skin integrity. Sickle cell disease is not a communicable disease, so rooming the burn patient with a 4-year-old with sickle-cell disease would not pose an increased risk of infection transmission. Rooming the burn patient with a 12-year-old with chickenpox would increase the risk of infection for the burn patient. Rooming with a 6-year-old undergoing chemotherapy may expose the burn patient to potential infections. A 7-year-old with a high temperature could potentially have a contagious illness, which could be risky for the burn patient.

4. A nurse prepares to care for a 4-year-old newly admitted for rhabdomyosarcoma. The nurse should alert the staff to pay more attention to the function of which area of the body?

• A. All striated muscles
• B. The cerebellum
• C. The kidneys
• D. The leg bones

Correct answer: A

Rationale: Rhabdomyosarcoma is the most common soft tissue sarcoma in children, originating in striated (skeletal) muscles and potentially affecting any part of the body. Symptoms vary based on the location of the tumor. In the head or neck area, symptoms may include sudden bulging or swelling of the eyes, conjunctival chemosis, and headache. Rhabdomyosarcoma can also impact organs like the urinary or reproductive system. Common metastatic sites include the lungs. Therefore, the nurse should pay attention to the function of all striated muscles in the child to monitor for any signs or symptoms related to the disease. Choices B, C, and D are incorrect as rhabdomyosarcoma primarily involves striated muscles and does not specifically target the cerebellum, kidneys, or leg bones.

5. A patient is admitted to the hospital with a diagnosis of primary hyperparathyroidism. A nurse checking the patient's lab results would expect which of the following changes in laboratory findings?

• A. Elevated serum calcium
• B. Low serum parathyroid hormone (PTH)
• C. Elevated serum vitamin D
• D. Low urine calcium

Correct answer: A

Rationale: In primary hyperparathyroidism, there is excess secretion of parathyroid hormone (PTH) leading to increased resorption of calcium from bones and decreased excretion of calcium by the kidneys. This results in elevated serum calcium levels. Elevated serum calcium is a hallmark characteristic of primary hyperparathyroidism, making it the correct answer. Low serum parathyroid hormone (PTH) (Choice B) is incorrect because primary hyperparathyroidism is associated with elevated PTH levels due to the malfunction of the parathyroid glands. Elevated serum vitamin D (Choice C) is incorrect because primary hyperparathyroidism is not typically associated with elevated vitamin D levels. Low urine calcium (Choice D) is incorrect as primary hyperparathyroidism leads to decreased calcium excretion by the kidneys, resulting in high levels of calcium in the urine.

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