Nursing Elites

1. An examiner is using an ophthalmoscope to examine a patient's eyes. The patient has astigmatism and is nearsighted. Which of these techniques by the examiner would indicate that the examination is being correctly performed?

• A. Rotating the lens selector dial to bring the object into focus
• B. Using the large full circle of light when assessing pupils that are not dilated
• C. Rotating the lens selector dial to the black numbers to compensate for astigmatism
• D. Using the grid on the lens aperture dial to visualize the external structures of the eye

Correct answer: A

Rationale: To correctly perform an eye examination using an ophthalmoscope on a patient with astigmatism and nearsightedness, the examiner should rotate the lens selector dial to bring the object into focus. This adjustment helps compensate for nearsightedness or farsightedness but does not correct astigmatism. Rotating the lens selector dial to the black numbers is not an appropriate technique for compensating for astigmatism. Using the grid on the lens aperture dial is primarily for visualizing external structures of the eye, not for addressing refractive errors. The large full circle of light is typically used when assessing dilated pupils, not for examining patients with astigmatism and nearsightedness. Therefore, the correct technique is rotating the lens selector dial to bring the object into focus.

2. A client is about to have a TENS unit attached for pain relief. Which of the following actions is most appropriate in this situation?

• A. Inform the client that he may experience tingling sensations.
• B. Connect the TENS unit before the client goes to bed for the night.
• C. Inform the client that the TENS unit may have pain-reducing effects for 10 to 15 days.
• D. After treatment, inform the client that he may not use a TENS unit again for at least 2 weeks.

Correct answer: A

Rationale: When attaching a TENS unit for pain relief, it is essential to inform the client that he may experience tingling sensations. This is a common sensation experienced when using a TENS unit, but it should not cause muscle twitching. The therapeutic effects of a TENS unit usually last between 3 to 5 days. Choice B is incorrect because there is no specific recommendation to connect the TENS unit before bedtime. Choice C is incorrect as stating that the TENS unit may have pain-reducing effects for 10 to 15 days is inaccurate, as the effects typically last 3 to 5 days. Choice D is incorrect because there is no guideline suggesting that the client cannot use a TENS unit again for at least 2 weeks after treatment.

3. While percussing over the liver of a patient, the nurse notices a dull sound. What should the nurse do?

• A. Consider this a normal finding
• B. Palpate this area for an underlying mass
• C. Reposition the hands and attempt to percuss in this area again
• D. Consider this finding as abnormal and refer the patient for additional treatment

Correct answer: A

Rationale: When percussing over relatively dense organs, such as the liver or spleen, a dull sound is a normal finding due to the organ's density. This occurs because the sound waves produced by tapping on the organ travel through the dense tissue, resulting in a dull sound. Therefore, the correct action for the nurse in this scenario is to consider a dull sound over the liver as a normal finding. Palpating for an underlying mass (Choice B) is not indicated based on the percussion finding alone. Repositioning the hands and repeating the percussion (Choice C) may not change the dull sound over the liver. Referring the patient for additional treatment (Choice D) without understanding the normal percussion findings over the liver would be premature. Thus, the most appropriate action is to interpret the dull sound as a normal finding.

4. What is the MOST ACCURATE statement regarding the ESR test?

• A. The results are diagnostic for certain conditions.
• B. Abnormal results are indicative of a potentially fatal illness.
• C. Abnormal results should be followed by additional testing.
• D. Results are reported in millimeters per hour.

Correct answer: C

Rationale: The erythrocyte sedimentation rate (ESR) is a non-specific screening test for inflammation in the body. It is not used as a definitive diagnostic tool for specific conditions. When ESR results are abnormal, they indicate the presence of inflammation, which can be caused by various reasons. Therefore, abnormal results should be followed by additional testing to determine the underlying cause. The ESR test measures the rate at which red blood cells settle in a vertical tube over the span of one hour, and results are reported in millimeters per hour. Choice A is incorrect because ESR results are not solely diagnostic for any specific condition. Choice B is incorrect as abnormal ESR results do not directly indicate a potentially fatal illness without further investigation. Choice D is incorrect as the results are reported in millimeters per hour, not per minute.

5. Which of the following descriptors is most appropriate to use when stating the 'problem' part of a nursing diagnosis?

• A. Grimacing
• B. Anxiety
• C. Oxygenation saturation 93%
• D. Output 500 mL in 8 hours

Correct answer: B

Rationale: The problem part of a nursing diagnosis in the context of nursing care plans should focus on the client's response to a life process, event, or stressor. This response is what is used to identify the nursing diagnosis. 'Anxiety' is the most appropriate descriptor for the problem part of a nursing diagnosis as it reflects a psychological response that can be addressed by nursing interventions. 'Grimacing' is a physical manifestation and not the problem itself. 'Oxygenation saturation 93%' and 'Output 500 mL in 8 hours' are data points or cues that a nurse would use to formulate the nursing diagnostic statement, not the actual problem being addressed.

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