Nursing Elites

1. A public health nurse is responsible for the administration of numerous immunizations. Which of the following guidelines regarding anaphylaxis should the nurse adhere to?

• A. The patient should be observed for anaphylaxis for 1 minute after administration.
• B. The patient should be observed for anaphylaxis for 5 minutes after administration.
• C. The patient should be observed for anaphylaxis for 30 minutes after administration.
• D. The patient should be observed for anaphylaxis for 90 minutes after administration.

Correct answer: C

Rationale: The correct answer is C: 'The patient should be observed for anaphylaxis for 30 minutes after administration.' This is because anaphylaxis can occur within minutes of administration of an immunization. By observing the patient for 30 minutes, the nurse can promptly identify and manage any signs of anaphylaxis. Choices A, B, and D are incorrect as they suggest shorter or longer observation periods, which may not be sufficient to detect and respond to anaphylaxis in a timely manner.

2. During a home visit to a family of three: a mother, father, and their child, the mother tells the community nurse that the father (who is not present) had hit the child on several occasions when he was drinking. The mother further explains that she has talked her husband into going to Alcoholics Anonymous and asks the nurse not to interfere so her husband won’t get angry and refuse treatment. Which of the following is the best response of the nurse?

• A. The nurse agrees not to interfere if the husband attends an Alcoholics Anonymous meeting that evening.
• B. The nurse commends the mother’s efforts and agrees to let her handle things.
• C. The nurse commends the mother’s efforts and also contacts protective services.
• D. The nurse confronts the mother’s failure to protect the child.

Correct answer: C

Rationale: In this situation, the best response for the nurse is to commend the mother's efforts in seeking help for her husband by encouraging him to attend Alcoholics Anonymous. However, it is crucial for the nurse to also contact protective services to ensure the safety and well-being of the child. Option A is incorrect as it is not appropriate to condition non-interference on the husband attending a meeting that evening. Option B is incorrect because solely letting the mother handle things might put the child at risk. Option D is incorrect as it does not address the immediate need to ensure the child's safety through involving protective services.

3. Which of the following clinical findings in a 51-year-old woman is consistent with Graves disease?

• A. Thin hair, exophthalmos, hyperreflexia, and pretibial edema.
• B. Thin hair, exophthalmos, weight gain, and constipation.
• C. Thick hair, bradycardia, weight loss, and dry skin.
• D. Thick hair, bradycardia, weight gain, and constipation.

Correct answer: A

Rationale: The clinical findings of thin hair, exophthalmos (bulging eyes), hyperreflexia, and pretibial edema are classic manifestations of Graves disease, an autoimmune condition that results in hyperthyroidism. Choice B is incorrect because weight gain and constipation are more indicative of hypothyroidism, not hyperthyroidism seen in Graves disease. Choice C is incorrect as the symptoms described are more characteristic of hypothyroidism, not hyperthyroidism. Choice D is also incorrect as the symptoms listed are not consistent with Graves disease but rather suggest hypothyroidism.

4. Which of the following hormones do the kidneys secrete to increase red blood cell production?

• A. Erythropoietin
• B. Insulin and glycogen
• C. Testosterone
• D. Thyroid stimulating hormone

Correct answer: A

Rationale: The correct answer is A: Erythropoietin. The kidneys produce erythropoietin to stimulate the production of red blood cells. Insulin and glycogen are not hormones secreted by the kidneys; insulin is produced by the pancreas, and glycogen is a stored form of glucose. Testosterone is a hormone primarily produced by the testes in males and to a lesser extent in females. Thyroid stimulating hormone is produced by the pituitary gland to regulate thyroid function, not red blood cell production.

5. When planning care for a cardiac patient, the nurse knows that in response to an increased workload, cardiac myocardial cells will:

• A. Increase in size
• B. Decrease in length
• C. Increase in excitability
• D. Increase in number

Correct answer: A

Rationale: The correct answer is A: Increase in size. Cardiac hypertrophy occurs when myocardial cells increase in size to compensate for an increased workload. This adaptation allows the heart to pump more effectively. Choice B, Decrease in length, is incorrect as cardiac cells do not decrease in length in response to increased workload. Choice C, Increase in excitability, is incorrect as increased workload does not lead to an increase in excitability of cardiac cells. Choice D, Increase in number, is incorrect as cardiac cells do not increase in number but rather increase in size to handle the increased workload.

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