Nursing Elites

1. A patient with Addison's disease asks a nurse for nutrition and diet advice. Which of the following diet modifications is not recommended?

• A. A diet high in grains
• B. A diet with adequate caloric intake
• C. A high protein diet
• D. A restricted sodium diet

Correct answer: D

Rationale: For a patient with Addison's disease, a restricted sodium diet is not recommended. These patients require normal dietary sodium to prevent excess fluid loss. Patients with primary adrenal insufficiency (Addison disease) should have ample access to salt because of the salt wasting that occurs if their condition is untreated. Therefore, a diet high in grains, a diet with adequate caloric intake, and a high protein diet are all recommended for patients with Addison's disease to support their nutritional needs and overall health. However, restricting sodium can be detrimental for these patients due to the nature of their condition.

2. Which technological advance is MOST likely to place you at risk for HIPAA violations?

• A. Social media
• B. Word processing programs
• C. Spreadsheets
• D. Cloud storage services (Clouds and SOEs)

Correct answer: A

Rationale: The correct answer is Social media. Social media platforms such as Facebook can significantly put you at risk for HIPAA violations. It is crucial to never share any patient-related information or comments on social media websites, as this breaches patient confidentiality and violates HIPAA regulations. Choices B, C, and D are less likely to directly lead to HIPAA violations. Word processing programs and spreadsheets are commonly used for documentation and data organization, focusing more on internal operations and not on external sharing of sensitive information that can compromise patient confidentiality. Cloud storage services (Clouds and SOEs) are designed for secure data storage and sharing within regulated environments, and HIPAA compliance can be maintained if used appropriately. However, social media's open and unsecured nature makes it a higher risk for HIPAA violations compared to the other technological advances mentioned.

3. A client in labor has an electronic fetal monitor attached to the abdomen, and the nurse notes that the baby's heart rate slows down during each contraction, returning to normal limits only after the contraction is complete. Which type of fetal heart rate change does this pattern describe?

• A. Variable decelerations
• B. Late decelerations
• C. Early decelerations
• D. Accelerations

Correct answer: B

Rationale: Late decelerations refer to a pattern where the baby's heart rate decreases during contractions and does not return to normal until after the contraction ends. This is considered a non-reassuring sign as it indicates potential fetal distress. Late decelerations are associated with uteroplacental insufficiency, and immediate medical attention is required. Variable decelerations (Choice A) are abrupt, unpredictable decreases in the fetal heart rate, usually associated with cord compression. Early decelerations (Choice C) are usually benign and mirror the contraction pattern. Accelerations (Choice D) are reassuring signs of fetal well-being, characterized by an increase in the fetal heart rate.

4. A nurse is performing an end-of-shift count of narcotics kept in the locked cabinet. The narcotic log states there should be 26 oxycodone pills left, but there are only 24 in the drawer. What is the first action of the nurse?

• A. Perform the count again
• B. Contact the pharmacy to determine if the narcotic log is incorrect
• C. Check with the last nurse to sign out narcotics from the system
• D. Notify the house supervisor that narcotic medications are missing

Correct answer: A

Rationale: The first action the nurse should take in this situation is to perform the count again. This step is crucial to ensure there was no miscount during the initial check. By verifying the count, the nurse can confirm if there is indeed a discrepancy in the number of oxycodone pills. Contacting the pharmacy, checking with the last nurse, or notifying the house supervisor should only be considered after ensuring the count is accurate. It's important to rule out any human error before escalating the issue to others.

5. The nurse is providing disease prevention education to a 63-year-old woman with a negative family history of breast cancer. The nurse recommends the patient schedule mammograms with which frequency?

• A. Every 5 years
• B. Every 10 years
• C. Every other year
• D. Once a year

Correct answer: C

Rationale: Mammograms, along with breast self-examinations and other routine tests, are key for the early diagnosis and treatment of breast cancer. All major societies (WHO, ACS, USPSTF) recommend a screening mammogram every two years in women of this age at average risk of breast cancer. The recommended frequency may change if there are identified family history and significant risk factors. Choosing 'Once a year' is too frequent and not aligned with current guidelines. Opting for 'Every 5 years' or 'Every 10 years' intervals is not adequate for regular breast cancer screening and may increase the risk of cancer progression. Therefore, 'Every other year' is the most appropriate choice for this patient without a family history of breast cancer.

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