Nursing Elites

1. An infant is brought to the clinic by his mother, who has noticed that he holds his head in an unusual position and always faces to one side. Which of the following is the most likely explanation?

• A. Torticollis, with shortening of the sternocleidomastoid muscle
• B. Craniosynostosis, with premature closure of the cranial sutures
• C. Plagiocephaly, with flattening of one side of the head
• D. Hydrocephalus, with increased head size

Correct answer: A

Rationale: The correct answer is torticollis, characterized by the shortening of the sternocleidomastoid muscle, limiting the range of motion of the neck and causing the chin to point to the opposing side. Craniosynostosis is the premature closure of cranial sutures, leading to an abnormal head shape but not necessarily affecting head position. Plagiocephaly is flattening of one side of the head due to external forces or positioning, not muscle shortening. Hydrocephalus presents with an increased head size due to the accumulation of cerebrospinal fluid, not with a fixed head position.

2. What is a key principle of patient teaching that must take place to ensure patient safety?

• A. Family members should be present
• B. Teaching must be documented
• C. Understanding must be confirmed
• D. Teaching should be provided by multiple staff members

Correct answer: C

Rationale: A key principle of patient teaching that ensures patient safety is the confirmation of understanding. To ensure patient safety, it is crucial to confirm that the patient comprehends the information provided. This confirmation can be achieved by having the patient repeat back the information or demonstrate understanding through return demonstration. Documenting the patient's understanding is essential to track the effectiveness of the teaching session and ensure that the patient is equipped with the necessary knowledge for their safety. Family members being present or having multiple staff members provide teaching may be beneficial in certain situations, but the primary focus should be on confirming the patient's understanding to enhance safety and promote effective learning.

3. The clinic nurse teaches a patient with a 42 pack-year history of cigarette smoking about lung disease. Which information will be most important for the nurse to include?

• A. Options for smoking cessation
• B. Reasons for annual sputum cytology testing
• C. Erlotinib (Tarceva) therapy to prevent tumor risk
• D. Computed tomography (CT) screening for lung cancer

Correct answer: A

Rationale: The most critical information for the nurse to provide to a patient with a significant smoking history is options for smoking cessation. Smoking is the primary cause of lung cancer, making smoking cessation essential in reducing the risk of developing the disease. Annual sputum cytology testing is not a standard screening test for lung cancer; instead, CT scanning is being explored for this purpose. Erlotinib therapy is used in lung cancer treatment but not for preventing tumor risk in individuals without cancer. CT screening for lung cancer is still under investigation and is not primarily aimed at prevention but rather early detection in high-risk individuals.

4. While caring for a client in labor, a nurse attaches an electronic fetal monitor to the client's abdomen to assess the baby's heart rate. The nurse observes that the baby's heart rate slows down during each contraction and does not return to normal limits until after the contraction is complete. What 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 are characterized by the baby's heart rate declining in utero during contractions. The heart rate drops below baseline and stays low until after the contraction ends. Late decelerations are concerning as they indicate uteroplacental insufficiency, which can compromise fetal oxygenation. This pattern is a non-reassuring sign and requires immediate intervention. Variable decelerations are typically abrupt decreases in heart rate, often associated with cord compression. Early decelerations, on the other hand, mirror the contractions and are considered benign, resulting from fetal head compression. Accelerations are reassuring signs of fetal well-being, indicating a responsive and healthy fetal nervous system.

5. Which of the following is an example of libel?

• A. A client overhears a nurse telling her assistant that he is 'too high maintenance.'
• B. A client reads disparaging remarks that a nurse has written about him in his chart.
• C. A nurse fails to notify a physician when a client's hemoglobin level is 8.1 gm/dL.
• D. A nurse administers narcotic pain medication to a client in pain but does not have an order.

Correct answer: B

Rationale: Libel involves making defamatory statements against another person in written form. These statements can harm the person's reputation or feelings. In this scenario, the correct answer is when a client reads disparaging remarks that a nurse has written about him in his chart. This constitutes libel because the negative remarks are written down and can potentially damage the client's reputation. Choices A, C, and D do not involve libel. Choice A describes a verbal statement, not written, so it does not constitute libel. Choice C involves a failure to notify a physician, which is a different issue unrelated to libel. Choice D pertains to administering medication without an order, which is a matter of improper practice rather than libel.

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