Nursing Elites

1. In planning the use of resources for secondary prevention in a community clinic serving migrant families, which activity should be the priority?

• A. Skin testing for tuberculosis.
• B. Glucose monitoring for diabetes.
• C. Blood work for cardiovascular disease.
• D. Height and weight for altered nutrition.

Correct answer: A

Rationale: The correct answer is A: Skin testing for tuberculosis. In a community clinic serving migrant families, tuberculosis is a significant health concern due to close living conditions and potential exposure during migration. Skin testing for tuberculosis is crucial for secondary prevention as it helps in early detection and prevention of the spread of the disease within the community. Choices B, C, and D are important health screenings but may not be the priority in this specific population where tuberculosis poses a higher risk.

2. The Healthy People project is designed to:

• A. track health care trends to anticipate insurance liabilities, especially for poor and urban populations
• B. demonstrate that social factors have a significant impact on individual and community health
• C. follow health indicators such as activity, substance use, mental health, and environmental issues
• D. demonstrate that access to health care in the United States is adequate for all populations

Correct answer: C

Rationale: The Healthy People project is designed to follow health indicators such as activity, substance use, mental health, and environmental issues to improve public health outcomes. Choice A is incorrect because the project focuses on public health indicators rather than insurance liabilities. Choice B is incorrect as the project actually acknowledges the significant impact of social factors on health. Choice D is incorrect because one of the main goals of the Healthy People project is to identify and address disparities in access to healthcare, not to demonstrate that access is adequate for all populations.

3. A client comes into the community health center upset and crying stating, “I will die of cancer now that I have this disease.” And then the client hands the nurse a paper with one word written on it: 'Pheochromocytoma.' Which response should the nurse state initially?

• A. 'Pheochromocytomas usually aren't cancerous (malignant). But they may be associated with cancerous tumors in other endocrine glands such as the thyroid (medullary carcinoma of the thyroid).'
• B. 'This problem is diagnosed by blood and urine tests that reveal elevated levels of adrenaline and noradrenaline.'
• C. 'Computerized tomography (CT) or magnetic resonance imaging (MRI) are used to detect an adrenal tumor.'
• D. 'You probably have had episodes of sweating, heart pounding, and headaches.'

Correct answer: A

Rationale: The correct initial response for the nurse to provide in this situation is to offer reassurance. Stating that 'Pheochromocytomas usually aren't cancerous (malignant)' helps to alleviate the client's anxiety and fear of having cancer. This response also establishes a foundation for further discussion about the condition, allowing the nurse to address the client's concerns and provide accurate information. Choice B is incorrect as it focuses solely on the diagnostic tests for pheochromocytoma but does not address the client's emotional distress. Choice C is incorrect as it discusses imaging modalities without directly addressing the client's concerns. Choice D is also incorrect as it assumes symptoms without first addressing the client's emotional state and fear of cancer.

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. The client with acute hypocalcemia is admitted to the unit. Nursing action should include:

• A. Implement seizure precautions
• B. Assess for hypoglycemia
• C. Monitor for visual changes
• D. Observe for muscle weakness

Correct answer: A

Rationale: The correct action for a client with acute hypocalcemia is to implement seizure precautions. Hypocalcemia can lead to tetany and seizures due to neuromuscular irritability. Assessing for hypoglycemia (choice B) is not directly related to hypocalcemia. Monitoring for visual changes (choice C) is more indicative of conditions like hyperglycemia or retinal disorders. Observing for muscle weakness (choice D) is a common symptom of hypocalcemia but does not address the immediate risk of seizures, which is why implementing seizure precautions is the priority nursing action.

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