Nursing Elites

1. The nurse is screening children at a local community health clinic for infectious diseases. Which child is at highest risk for hepatitis B virus (HBV)?

• A. A newborn.
• B. A 3-year-old.
• C. A 7-year-old.
• D. An 11-year-old.

Correct answer: A

Rationale: The correct answer is A: a newborn. Newborns are at the highest risk for HBV due to potential transmission from the mother. The hepatitis B virus can be transmitted from an infected mother to her baby during childbirth. Choices B, C, and D are incorrect because newborns have a higher risk due to this mode of transmission, making them more vulnerable compared to older children.

2. The nurse is planning care for a client with increased intracranial pressure. The best position for this client is

• A. Trendelenburg
• B. Prone
• C. Semi-Fowler's
• D. Side-lying with head flat

Correct answer: C

Rationale: The correct answer is C, Semi-Fowler's. This position helps to reduce intracranial pressure by promoting venous drainage from the head while maintaining adequate oxygenation. Option A, Trendelenburg position, is incorrect as it involves placing the patient with the head lower than the body, which can increase intracranial pressure. Option B, Prone position, is also incorrect as it involves lying on the stomach, which can further elevate intracranial pressure. Option D, Side-lying with head flat, does not provide the same benefits as the Semi-Fowler's position in terms of promoting venous drainage and maintaining oxygenation in a client with increased intracranial pressure.

3. Which of the following patients should the home care nurse assess first?

• A. A 65-year-old male with known COPD and difficulty breathing after climbing a flight of stairs.
• B. A 78-year-old with CHF who has gained 4 lbs according to her tele-monitoring.
• C. A 50-year-old with bilateral leg swelling and difficulty walking.
• D. A 60-year-old with lower back pain.

Correct answer: A

Rationale: The correct answer is A. A patient with known COPD and difficulty breathing after physical exertion like climbing stairs requires immediate assessment by the nurse. This could indicate a potential exacerbation of COPD, which needs prompt intervention to prevent respiratory distress. Choices B, C, and D describe important patient situations that also require attention, but the urgency is higher with a COPD patient experiencing difficulty breathing.

4. Which playroom activities should the nurse organize for a small group of 7-year-old hospitalized children?

• A. Sports and games with rules
• B. Finger paints and water play
• C. "Dress-up" clothes and props
• D. Chess and television programs

Correct answer: A

Rationale: Sports and games with rules are appropriate for the cognitive development stage of 7-year-olds.

5. During the care of a client with Legionnaire's disease, which finding would require the nurse's immediate attention?

• A. Pleuritic pain on inspiration
• B. Dry mucus membranes in the mouth
• C. A decrease in respiratory rate from 34 to 24
• D. Decrease in chest wall expansion

Correct answer: D

Rationale: A decrease in chest wall expansion suggests that the client may be experiencing a serious complication, such as worsening pneumonia or respiratory failure, requiring immediate medical attention. This finding indicates a potential decrease in lung function, which could lead to respiratory distress. Pleuritic pain on inspiration may be related to the disease process but does not indicate an immediate need for intervention. Dry mucus membranes in the mouth may require attention but are not as critical as a decrease in chest wall expansion. A decrease in respiratory rate could be concerning but is not as urgent as a decrease in chest wall expansion, which directly impacts respiratory function.

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