Nursing Elites

1. A patient's body temperature has varied over the last 24 hours from 97.6 degrees F in the morning to 99 degrees F in the evening. The patient is worried that this change in temperature may indicate the beginning of a fever. Which of the following BEST explains this phenomenon?

• A. The patient definitely has a fever in the evening and should be seen by a doctor.
• B. The patient is experiencing changes related to a diurnal rhythm.
• C. The patient is more than likely taking their temperature incorrectly.
• D. The patient is experiencing changes related to fluctuating daily hormones.

Correct answer: B

Rationale: The patient is experiencing changes related to a diurnal rhythm. Diurnal rhythm is the phenomenon of body temperature fluctuating depending on the time of day. Temperatures taken in the morning are typically lower than those taken throughout the rest of the day. Choice A is incorrect because a single elevated temperature reading in the evening does not definitively indicate a fever. Choice C is incorrect as there is no indication of incorrect temperature measurement. Choice D is incorrect as the temperature changes are not related to monthly hormones but rather to the body's natural daily rhythm.

2. During a class on religion and spirituality, the nurse is asked to define spirituality. Which statement by the nurse best describes spirituality?

• A. "Is a personal search to discover a supreme being."?
• B. "Is an organized system of beliefs concerning the cause, nature, and purpose of the universe."?
• C. "Is a belief that each person exists forever in some form, such as a belief in reincarnation or the afterlife."?
• D. "Focuses on a connection with something bigger than oneself and a belief in transcendence."?

Correct answer: D

Rationale: Spirituality is a broad term that focuses on a connection with something greater than oneself and a belief in transcendence. It is a personal journey that arises from unique life experiences and the individual's quest to find purpose and meaning in life. The correct answer emphasizes the essence of spirituality, which involves seeking a connection with a higher power and believing in transcendence. Choices A, B, and C, on the other hand, define aspects of religion rather than spirituality. Choice A refers to a personal search for a supreme being, which is more aligned with religious beliefs. Choice B describes an organized system of beliefs about the universe, typically associated with religion. Choice C pertains to beliefs about existence after death, such as reincarnation or the afterlife, which are often religious concepts. Therefore, the best description of spirituality is focusing on a connection with something beyond oneself and a belief in transcendence.

3. Your elderly patient has a temperature of 98.5 degrees. Is there anything else that a nurse should do, in addition to documenting this temperature?

• A. No, this temperature is within normal limits.
• B. No, this temperature is normally hyperthermic.
• C. Yes, this temperature is highly hyperthermic.
• D. Yes, this temperature is highly hypothermic.

Correct answer: A

Rationale: No, there is nothing else that a nurse should do. A temperature of 98.5 degrees for an elderly patient falls within normal limits. Other choices are incorrect because the temperature is not hyperthermic (abnormally high) or hypothermic (abnormally low), making choices B, C, and D inaccurate responses in this scenario.

4. During a general survey of a patient, which finding is considered normal?

• A. Body mass index (BMI) of 20.
• B. When standing, the patient's base is narrow.
• C. The patient appears older than their stated age.
• D. Arm span (fingertip to fingertip) is greater than the height.

Correct answer: A

Rationale: A body mass index (BMI) of 20 is considered normal as the range for a normal BMI is between 19-24. When standing, a patient's base should be wide for stability and proper weight distribution. An older appearance than the stated age may indicate a history of chronic illness or chronic alcoholism. In a general survey, the patient's arm span (fingertip to fingertip) should approximately equal the patient's height. An arm span greater than the height may suggest Marfan syndrome. Therefore, the correct choice is a normal BMI of 20, which falls within the healthy range. Choices B, C, and D all describe abnormal findings that may indicate underlying health conditions or syndromes.

5. As a charge nurse, what is your primary responsibility for a 50-year-old blind and deaf patient admitted to your floor?

• A. Inform others about the patient's deficits.
• B. Communicate patient safety concerns to your supervisor.
• C. Provide continuous updates to the patient about the social environment.
• D. Provide a secure environment for the patient.

Correct answer: D

Rationale: The primary responsibility of the charge nurse for a blind and deaf patient is to provide a secure environment. Ensuring patient safety is crucial to prevent medical errors and adverse outcomes. By creating a safe environment, the nurse can protect the patient from harm and promote well-being. Option A is incorrect as the focus should be on ensuring patient safety rather than highlighting deficits. Option B is not the primary responsibility in this scenario, as the immediate concern is the patient's safety. Option C is irrelevant and does not address the patient's primary needs, which are safety and security.

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