Nursing Elites

1. An adolescent brings a physician's note to school stating that he is not to participate in sports due to a diagnosis of Osgood-Schlatter disease. Which of the following statements about the disease is correct?

• A. The condition is not caused by the student's competitive swimming schedule.
• B. The student will most likely not require surgical intervention.
• C. The student experiences pain in the inferior aspect of the knee.
• D. The student is not trying to avoid participation in physical education.

Correct answer: C

Rationale: Osgood-Schlatter disease occurs in adolescents during the rapid growth phase when the infrapatellar ligament of the quadriceps muscle pulls on the tibial tubercle, causing pain and swelling in the inferior aspect of the knee. The condition is commonly caused by activities that require repeated use of the quadriceps, such as track and soccer. Choice A is incorrect because Osgood-Schlatter disease is not specifically linked to competitive swimming. Choice B is incorrect as surgical intervention is not usually necessary for this condition. Choice D is incorrect as the student is not trying to avoid physical education but is restricted from participating in sports due to the diagnosis of Osgood-Schlatter disease.

2. The client is receiving discharge teaching seven (7) days post myocardial infarction and inquires why he must wait six (6) weeks before engaging in sexual intercourse. What is the best response by the nurse to this question?

• A. "You need to regain your strength before attempting such exertion."?
• B. "When you can climb 2 flights of stairs without problems, it is generally safe."?
• C. "Have a glass of wine to relax you, then you can try to have sex."?
• D. "If you can maintain an active walking program, you will have less risk."?

Correct answer: B

Rationale: Following a myocardial infarction, there is a risk of cardiac rupture at the site of the infarction for approximately six (6) weeks until scar tissue forms. The advice to wait until the client can climb two flights of stairs without issues is common among healthcare providers as it indicates an adequate level of physical exertion tolerance and suggests a lower risk of complications during sexual activity. Choice A is not specific to the recovery timeline related to sexual activity post-myocardial infarction. Choice C is inappropriate as alcohol consumption should not be recommended before sexual activity. Choice D, though promoting an active lifestyle, does not directly address the safety concerns related to sexual intercourse post-myocardial infarction.

3. A 58-year-old client is being tested for rheumatoid arthritis. Her physician orders an erythrocyte sedimentation rate (ESR). Which of the following results is most likely to be associated with arthritis?

• A. 5 mm/hr
• B. 12 mm/hr
• C. 28 mm/hr
• D. 40 mm/hr

Correct answer: D

Rationale: The erythrocyte sedimentation rate (ESR) measures levels of inflammation in the body. Elevated ESR levels are commonly seen in autoimmune conditions like rheumatoid arthritis due to the presence of inflammation. In women over 50 years old, a normal ESR is typically below 30 mm/hr. Therefore, a result of 40 mm/hr is more indicative of arthritis in a 58-year-old individual. Choices A, B, and C are below the normal ESR range for a woman of this age and would not be as strongly associated with arthritis.

4. During an adolescent examination, the nurse asks a 13-year-old female to bend forward at the waist with arms hanging freely. Which of the following assessments is the nurse most likely conducting?

• A. Spinal flexibility
• B. Leg length disparity
• C. Hypostatic blood pressure
• D. Scoliosis

Correct answer: D

Rationale: The correct answer is scoliosis. During the assessment for scoliosis, the nurse asks the adolescent to bend forward at the waist with arms hanging freely to observe for any lateral deviation of the spine, uneven rib levels, or asymmetry. This assessment is a routine part of an adolescent examination, especially in females, as scoliosis is more common in this population. Choices A, B, and C are incorrect. Spinal flexibility is usually assessed through different maneuvers, leg length disparity is evaluated by measuring the length of the legs, and hypostatic blood pressure refers to a decrease in blood pressure due to immobility.

5. What action by the nurse will be most effective in decreasing the spread of pertussis in a community setting?

• A. Providing supportive care to patients diagnosed with pertussis
• B. Teaching family members about the importance of careful handwashing
• C. Teaching patients about the necessity of adult pertussis immunizations
• D. Encouraging patients to complete the prescribed course of antibiotics

Correct answer: C

Rationale: The most effective action by the nurse to decrease the spread of pertussis in a community setting is to teach patients about the necessity of adult pertussis immunizations. The increased rate of pertussis in adults is often attributed to waning immunity after childhood immunization. Immunization is highly effective in protecting communities from infectious diseases. While teaching about handwashing is important for overall infection control, pertussis is primarily spread through respiratory droplets and contact with secretions. Providing supportive care does not significantly impact the disease course or transmission risk. Encouraging completion of antibiotics may help reduce transmission, but patients likely have already spread the disease by the time the diagnosis is made. Therefore, the emphasis should be on prevention through immunization to reduce the spread of pertussis.

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