Nursing Elites

1. During an initial clinic visit, the nurse is taking the history for a client who wants to confirm her pregnancy. The client's last child has a history of low-birth-weight (LBW). Which additional finding is most important for the nurse to consider?

• A. Cigarette smoking.
• B. African American ethnicity.
• C. Poor nutritional status.
• D. Limited maternal education.

Correct answer: A

Rationale: The correct answer is A: Cigarette smoking. Cigarette smoking is a significant risk factor for low birth weight. Smoking during pregnancy reduces the amount of oxygen available to the baby, leading to LBW. Choice B, African American ethnicity, while it may be a risk factor, is not as directly linked to LBW as cigarette smoking. Choice C, poor nutritional status, can contribute to LBW but is not as significant as cigarette smoking in this case. Choice D, limited maternal education, is an important social determinant of health but is not as directly related to LBW as cigarette smoking.

2. You are teaching a client about the patient-controlled analgesia (PCA) planned for post-operative care. Which statement indicates further teaching may be needed by the client?

• A. ''I will be receiving continuous doses of medication.''
• B. ''I should call the nurse before I take additional doses.''
• C. ''I will call for assistance if my pain is not relieved.''
• D. ''The machine will prevent an overdose.''

Correct answer: B

Rationale: PCA allows patients to self-administer pain medication within prescribed limits, without the need to call the nurse before taking an additional dose. Choice B suggests a misunderstanding of how PCA works, as the patient should be educated that they can self-administer doses within the safety parameters set by the healthcare provider. Choices A, C, and D demonstrate proper understanding of PCA, hence are not indicative of needing further teaching.

3. A client with asthma has low-pitched wheezes present on the final half of exhalation. One hour later the client has high-pitched wheezes extending throughout exhalation. This change in assessment indicates to the nurse that the client

• A. Has increased airway obstruction
• B. Has improved airway obstruction
• C. Needs to be suctioned
• D. Exhibits hyperventilation

Correct answer: A

Rationale: The correct answer is A: 'Has increased airway obstruction.' High-pitched wheezes extending throughout exhalation indicate a worsening airway obstruction, leading to increased resistance in the airways. Low-pitched wheezes present on the final half of exhalation may suggest some level of obstruction, but the change to high-pitched wheezes throughout exhalation indicates a progression in the obstruction. Choice B is incorrect as the change in wheeze characteristics signifies deterioration rather than improvement. Choice C is incorrect as suctioning is not indicated based on the wheeze assessment findings. Choice D is incorrect as hyperventilation does not typically present with wheezes and is not supported by the information provided.

4. What are the sources of information about the family?

• A. Interview results with members of the family
• B. Family folder
• C. Actual observation of the family situation
• D. All these sources of information

Correct answer: D

Rationale: The correct answer is D because all the listed sources - interview results with family members, family folder, and actual observation of the family situation - provide comprehensive information about the family. Choice A alone (interview results) might not capture the complete picture of the family, as it may be biased or limited. Choice B (family folder) could contain valuable information but might not be up to date or comprehensive. Choice C (actual observation) is essential to understand the family dynamics, but it alone may not provide all the necessary information. Therefore, the combination of all these sources (D) is needed for a thorough understanding of the family.

5. Which of the following tools is used by community health nurses to identify the health needs of a population?

• A. Health survey
• B. Medical records
• C. Patient interviews
• D. Epidemiological studies

Correct answer: D

Rationale: Epidemiological studies are used by community health nurses to identify the health needs of a population. These studies involve investigating patterns, causes, and effects of health and disease conditions in defined populations. While health surveys, medical records, and patient interviews are valuable tools in healthcare, epidemiological studies provide a broader population-based perspective essential for understanding and addressing community health needs.

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