Nursing Elites

1. The nurse is speaking at a community meeting about personal responsibility for health promotion. A participant asks about chiropractic treatment for illnesses. What should be the focus of the nurse's response?

• A. Electrical energy fields
• B. Spinal column manipulation
• C. Mind-body balance
• D. Exercise of joints

Correct answer: B

Rationale: The focus of the nurse's response should be on spinal column manipulation when discussing chiropractic treatment for illnesses. Chiropractic theory emphasizes that misalignment of the vertebrae can interfere with the transmission of mental impulses between the brain and body organs, leading to diseases. Manipulation is aimed at reducing such misalignments, known as subluxations. While mind-body balance and exercise of joints are important aspects of holistic health, in the context of chiropractic treatment, the key intervention is spinal column manipulation to address vertebral misalignments. Therefore, choices A, C, and D are incorrect as they do not directly address the primary focus of chiropractic treatment.

2. A writer is admitted for the second time accompanied by his wife. He is demanding, arrogant, talks fast, and is hyperactive. Initially, the nurse should plan this for a manic client:

• A. Set realistic limits to the client's behavior
• B. Repeat verbal instructions as often as needed
• C. Allow the client to express feelings to relieve tension
• D. Assign a staff member to be with the client at all times to help maintain control

Correct answer: A

Rationale: For a manic client who is demanding, arrogant, talks fast, and is hyperactive, setting realistic limits to the client's behavior is essential to ensure safety as manic clients may engage in injurious activities. A quiet environment and consistent, firm limits help to maintain control. While repeating verbal instructions may be necessary due to distractibility, it is not the priority compared to setting limits for safety. Allowing the client to express feelings is important, but only non-destructive methods of expression should be permitted. Assigning a staff member to be with the client at all times is not a realistic approach as it may not always be feasible or necessary for managing manic behavior effectively.

3. A client with adrenal insufficiency has a potassium level of 7.2 mEq/L. Which of the following signs or symptoms might the client exhibit with this result?

• A. Peaked T waves on the ECG
• B. Muscle spasms
• C. Constipation
• D. A prominent U wave on the ECG

Correct answer: A

Rationale: A client with hyperkalemia may exhibit peaked T waves on an electrocardiogram. This manifestation is an early sign of high potassium levels, but diagnosis should not be based on this aspect alone. Untreated, hyperkalemia can lead to progressively worsening cardiac instability. Muscle spasms (Choice B) are more commonly associated with hypocalcemia. Constipation (Choice C) is not a typical sign of hyperkalemia. A prominent U wave on the ECG (Choice D) is associated with hypokalemia, not hyperkalemia.

4. In which of the following examples would informed consent not be required?

• A. A patient is apprehensive about an upcoming surgery and chooses not to learn of the risks involved with the procedure.
• B. A child is rushed to the Emergency Room after falling from a third-story window.
• C. An adult in a coma in a mental health institution with no listed next of kin.
• D. Informed consent is not required in any of the above examples.

Correct answer: D

Rationale: In emergency situations where immediate treatment is necessary to prevent further harm or save a life, such as in option B where a child is rushed to the Emergency Room after a fall, informed consent may be waived to provide prompt care. In option A, though the patient is apprehensive about surgery and chooses not to learn the risks, informed consent is not required as it is the patient's right to refuse information. In option C, when an adult is in a coma with no next of kin listed, decisions may be made in the patient's best interest following legal and ethical guidelines. Therefore, informed consent is not needed in any of the scenarios presented.

5. You are creating a teaching plan for a patient with newly diagnosed migraine headaches. Which key item should NOT be included in the teaching plan?

• A. Avoid foods that contain tyramine, such as alcohol and aged cheese.
• B. Avoid drugs such as Tagamet, nitroglycerin, and Nifedipine.
• C. Continue taking estrogen as prescribed by your physician.
• D. A potential side effect of medications is rebound headache.

Correct answer: C

Rationale: The correct answer is C: Continue taking estrogen as prescribed by your physician. Medications such as estrogen supplements may actually trigger a migraine headache attack. Fluctuations in estrogen, such as before or during menstrual periods, pregnancy, and menopause, seem to trigger headaches in many women. Choices A and B are important to include in the teaching plan for a patient with migraines as avoiding foods containing tyramine and certain drugs can help prevent migraine triggers. Choice D is also relevant as it is essential for the patient to be aware of potential side effects of medications, including rebound headaches.

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