Nursing Elites

1. The nurse is caring for a 75-year-old client in congestive heart failure. Which finding suggests that digitalis levels should be reviewed?

• A. Extreme fatigue
• B. Increased appetite
• C. Intense itching
• D. Constipation

Correct answer: A

Rationale: Extreme fatigue can be a sign of digitalis toxicity, especially in older adults, and warrants a review of the client's medication levels and potential adjustment. Increased appetite, intense itching, and constipation are not typically associated with digitalis toxicity and do not directly indicate a need for a review of digitalis levels.

2. Which topic should the nurse include in planning a primary prevention class for adolescents?

• A. Risk factors for heart disease.
• B. Dietary management of obesity.
• C. Suicide risks and prevention.
• D. Coping with stressful situations.

Correct answer: C

Rationale: The correct topic that the nurse should include in planning a primary prevention class for adolescents is suicide risks and prevention. Adolescents are particularly vulnerable to mental health issues, including suicidal ideation. Educating them about suicide risks and prevention strategies is crucial for early intervention and support. Choices A, B, and D are important topics, but when considering primary prevention for adolescents, addressing suicide risks and prevention takes precedence due to its immediate life-saving implications.

3. The nurse is caring for a 5-year-old child who has the left leg in skeletal traction. Which of the following activities would be an appropriate diversional activity?

• A. Kicking balloons with the right leg
• B. Playing 'Simon Says'
• C. Playing handheld games
• D. Throwing bean bags

Correct answer: C

Rationale: Playing handheld games is an appropriate diversional activity for a child in skeletal traction because it does not require physical movement of the affected limb. This activity can help keep the child entertained and engaged without risking any harm to the tractioned leg. Choices A, B, and D involve physical movements that could potentially interfere with the skeletal traction or cause discomfort to the child.

4. The major target of the Philippine Family Program are women belonging to the high-risk group which includes:

• A. Women under 20 or over 35 years old
• B. Women suffering from certain medical conditions that contradict pregnancy
• C. All these groups
• D. Women who have had at least 4 deliveries

Correct answer: C

Rationale: The correct answer is C, 'All these groups.' The Philippine Family Program targets women under 20 years old, over 35 years old, those with certain medical conditions that contradict pregnancy, and women who have had at least 4 deliveries. Therefore, choice C is the correct answer because it encompasses all the high-risk groups identified by the program. Choices A, B, and D are incorrect because they do not cover all the specified high-risk groups targeted by the program.

5. The nurse is reviewing a depressed client's history from an earlier admission. Documentation of anhedonia is noted. The nurse understands that this finding refers to:

• A. Reports of difficulty falling and staying asleep
• B. Expression of persistent suicidal thoughts
• C. Lack of enjoyment in usual pleasures
• D. Reduced senses of taste and smell

Correct answer: C

Rationale: The correct answer is C: Lack of enjoyment in usual pleasures. Anhedonia is the inability to feel pleasure in normally pleasurable activities. Choice A, reports of difficulty falling and staying asleep, is more indicative of insomnia rather than anhedonia. Choice B, expression of persistent suicidal thoughts, is related to suicidal ideation and not anhedonia. Choice D, reduced senses of taste and smell, is more associated with disturbances in the sense of taste and smell, not anhedonia.

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