Nursing Elites

1. When assessing a newborn infant with low set ears, short palpebral fissures, flat nasal bridge, and an indistinct philtrum, a priority maternal assessment by the nurse should be to ask about

• A. Alcohol use during pregnancy
• B. Usual nutritional intake
• C. Family genetic disorders
• D. Maternal and paternal ages

Correct answer: A

Rationale: The correct answer is A: Alcohol use during pregnancy. The physical features mentioned are indicative of fetal alcohol syndrome, a condition caused by maternal alcohol consumption during pregnancy. It is crucial for the nurse to inquire about alcohol use as it can help in diagnosing and managing the infant's condition. Choices B, C, and D are incorrect as they are not directly associated with the physical findings described in the newborn, which specifically point towards a potential history of alcohol exposure during pregnancy.

2. A client with chronic renal failure is receiving erythropoietin (Epogen). The nurse should monitor the client for which of the following side effects?

• A. Hypertension
• B. Hypoglycemia
• C. Hyperkalemia
• D. Hypocalcemia

Correct answer: A

Rationale: The correct answer is A: Hypertension. Erythropoietin can lead to hypertension as a side effect due to its stimulation of red blood cell production, which can increase blood viscosity. This can result in elevated blood pressure. Choices B, C, and D are incorrect. Hypoglycemia is not a common side effect of erythropoietin. Hyperkalemia is more commonly associated with renal failure rather than erythropoietin use. Hypocalcemia is not a typical side effect of erythropoietin administration.

3. Which individual has the highest risk of developing community-acquired pneumonia?

• A. A 40-year-old first-grade teacher who works with underprivileged children.
• B. A 75-year-old retired secretary with exercise-induced wheezing.
• C. A 60-year-old homeless person who is an alcoholic and smokes.
• D. A 35-year-old aerobics instructor who skips meals and eats only vegetables.

Correct answer: C

Rationale: The correct answer is the 60-year-old homeless person who is an alcoholic and smokes. This individual has the highest risk of developing community-acquired pneumonia due to factors such as homelessness, alcoholism, and smoking, which weaken the immune system and make them more susceptible to respiratory infections. Choice A is incorrect as working with underprivileged children, while potentially exposing the individual to various illnesses, does not directly increase the risk of pneumonia. Choice B is less likely as exercise-induced wheezing may suggest asthma but does not directly correlate with pneumonia risk. Choice D, an aerobics instructor who eats only vegetables and skips meals, does not have the same level of risk factors for pneumonia as the homeless person in choice C.

4. Which finding would be the most characteristic of an acute episode of reactive airway disease?

• A. Auditory gurgling
• B. Inspiratory laryngeal stridor
• C. Auditory expiratory wheezing
• D. Frequent dry coughing

Correct answer: C

Rationale: The correct answer is C: Auditory expiratory wheezing. Expiratory wheezing is a common sign of reactive airway disease, such as asthma, where airways are constricted, making it difficult to expel air from the lungs. Choices A, B, and D are incorrect as they are not typically associated with reactive airway disease. Auditory gurgling may suggest airway secretions or fluid accumulation, inspiratory laryngeal stridor indicates upper airway obstruction, and frequent dry coughing is more commonly seen in conditions like upper respiratory infections or postnasal drip.

5. Following-up Mrs. Luy, G5P4, you notice her eldest son is underweight and her youngest daughter looks thin and pale. Mrs. Luy's present pregnancy would mean another additional member of the family. This can be considered as:

• A. health deficit
• B. health deficit and health threat
• C. health threat
• D. foreseeable crisis

Correct answer: C

Rationale: The correct answer is C: 'health threat.' The new pregnancy poses a health threat due to the potential strain on resources and the existing issues with the children, such as underweight and being pale. Choice A is incorrect as it does not fully capture the potential risks associated with the new pregnancy. Choice B is also incorrect as it includes 'health deficit,' which is not explicitly mentioned in the scenario. Choice D, 'foreseeable crisis,' is not the most fitting description of the situation presented.

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