Nursing Elites

1. The wife of an older adult man who has had diabetes mellitus for the past 10 years reports to the home health nurse that her husband fell yesterday while taking his daily walk in the neighborhood. He has a bruised hand and a small abrasion on his left knee. The nurse assesses that his neurologic vital signs are stable. To reduce the risk for future falls, which assessment is most important for the nurse to obtain?

• A. current blood sugar level
• B. degree of paresthesia in feet
• C. wound healing of knee abrasion
• D. A1c glycosylated hemoglobin

Correct answer: B

Rationale: Assessing for paresthesia (numbness or tingling) in the feet is crucial in this scenario as it can help determine if the client has a loss of sensation, which increases the risk of falls. Paresthesia is a common complication of diabetes that can lead to decreased sensation and proprioception in the feet, contributing to balance issues and an increased risk of falls. Monitoring for paresthesia allows the nurse to assess the extent of sensory impairment and implement appropriate interventions to prevent future falls. While monitoring blood sugar levels (choice A) and A1c levels (choice D) are important in managing diabetes, in this case, assessing paresthesia takes precedence due to its direct impact on fall risk. Similarly, while monitoring the wound healing of the knee abrasion (choice C) is important for overall wound care, it is not directly related to reducing the risk of future falls in this situation.

2. A client presents at a community-based clinic with complaints of shortness of breath, headache, often uses a gasoline-powered pressure washer to clean equipment and farm buildings. Which type of poisoning is the most likely etiology of this client's symptoms?

• A. asbestos
• B. silica dust
• C. histoplasmosis
• D. carbon monoxide

Correct answer: D

Rationale: The correct answer is D, carbon monoxide poisoning. This client's symptoms of shortness of breath and headache are consistent with carbon monoxide exposure, which can result from using gasoline-powered equipment in poorly ventilated areas. Asbestos (choice A) is linked to respiratory issues but does not typically present with these acute symptoms. Silica dust (choice B) exposure is associated with lung damage, not the symptoms described. Histoplasmosis (choice C) is a fungal infection and would not typically manifest with the symptoms presented by the client.

3. A nurse is planning a community health fair to promote cardiovascular health. Which activity should be included to best engage participants?

• A. free blood pressure screenings
• B. lectures on heart-healthy diets
• C. distribution of pamphlets on heart disease
• D. cooking demonstrations of healthy recipes

Correct answer: A

Rationale: Offering free blood pressure screenings should be included in the community health fair to best engage participants. This activity provides immediate, valuable information about participants' cardiovascular health. Blood pressure screenings are interactive, engaging, and offer personalized insights that can motivate individuals to take action towards improving their heart health. Lectures on heart-healthy diets, distribution of pamphlets, and cooking demonstrations, although beneficial, may not have the same level of immediate impact and engagement as the hands-on experience of getting one's blood pressure checked.

4. During the physical assessment, which finding should the nurse recognize as a normal finding?

• A. Regular pulsation at the epigastric area when the client is supine.
• B. A loud, harsh murmur at the second right intercostal space.
• C. Dullness over the lung fields.
• D. Increased tactile fremitus.

Correct answer: A

Rationale: The regular pulsation at the epigastric area when the client is supine is a normal finding. This phenomenon is caused by the regular and recurrent expansion and contraction of an artery due to waves of pressure caused by the ejection of blood from the left ventricle. Choices B, C, and D describe abnormal findings during a physical assessment. A loud, harsh murmur at the second right intercostal space indicates an abnormal heart sound, dullness over the lung fields may suggest consolidation or fluid in the lungs, and increased tactile fremitus can be a sign of lung consolidation or pathology.

5. On a day when the temperature is expected to drop below freezing during the night, the nurse is asked to determine which homeless adults are most in need of the limited spaces available in a shelter. It is most important for which person to be admitted at night?

• A. an adult who was hit by a car 3 weeks ago
• B. a young person with diabetes mellitus
• C. a middle-aged person who has hypertension
• D. an older person who is malnourished

Correct answer: D

Rationale: Malnourished individuals are at higher risk of severe complications from cold exposure due to their weakened immune system and decreased ability to regulate body temperature. This places them at a greater risk of hypothermia and other cold-related conditions, making them the most vulnerable group in need of shelter. Choice A is not the most critical as the injury is from 3 weeks ago and should have received appropriate medical care by now. Choice B, a young person with diabetes mellitus, while vulnerable, can manage their condition with proper medication and care. Choice C, a middle-aged person with hypertension, may need monitoring but is less susceptible to immediate harm from cold exposure compared to a malnourished individual.

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