Nursing Elites

1. What action by the nurse is appropriate when examining a 16-year-old male teenager?

• A. Discuss health teaching with the teenager to promote wellness.
• B. Ask the parent to step out of the room during the history and physical examination to respect the teenager's privacy.
• C. Use age-appropriate communication when speaking to the teenager to ensure understanding.
• D. Provide feedback that his body is developing normally and discuss the wide variation among teenagers on the rate of growth and development.

Correct answer: D

Rationale: During the examination of a 16-year-old male teenager, it is essential to provide feedback that his body is developing normally and to discuss the wide variation among teenagers regarding growth and development. This reassures the teenager about his health status and addresses any concerns about physical development. It is important to recognize that adolescents are very conscious of their body image and often compare themselves to their peers, hence the need for such feedback. Asking the parent to step out of the room respects the teenager's privacy and promotes open communication between the nurse and the teenager. Using age-appropriate communication is crucial to ensure that the teenager understands the information provided. Asking the parent to stay in the room may not be ideal as it can inhibit open discussion, and talking to the teenager as if they were a younger child is inappropriate and may undermine their autonomy and understanding.

2. A 75-year-old man with a history of hypertension was recently changed to a new antihypertensive drug. He reports feeling dizzy at times. How would the nurse evaluate his blood pressure?

• A. Blood pressure and pulse should be recorded in the supine, sitting, and standing positions.
• B. The patient should be directed to walk around the room and his blood pressure assessed after this activity.
• C. Blood pressure and pulse are assessed at the beginning and at the end of the examination.
• D. Blood pressure is taken on the right arm and then 5 minutes later on the left arm.

Correct answer: A

Rationale: Orthostatic vital signs should be taken when the person is hypertensive or is taking antihypertensive medications, when the person reports fainting or syncope, or when volume depletion is suspected. The blood pressure and pulse readings are recorded in the supine, sitting, and standing positions.

3. A patient in a clinic has been diagnosed with hepatitis A. What is the most likely route of transmission?

• A. Sexual contact with an infected partner
• B. Contaminated food
• C. Blood transfusion
• D. Illegal drug use

Correct answer: B

Rationale: The correct answer is contaminated food. Hepatitis A is primarily transmitted through the fecal-oral route, often through the ingestion of contaminated food or water. It is caused by the Hepatitis A virus (HAV), which is a single-stranded, positive-sense RNA virus. Sexual contact with an infected partner is more commonly associated with hepatitis B and C. Blood transfusion is a potential route for hepatitis B and C transmission due to bloodborne pathogens. Illegal drug use, particularly involving shared needles, is a common route for hepatitis C transmission.

4. Where is the duodenum located in the digestive system?

• A. It is the first part of the small intestine, located immediately after the stomach.
• B. It is the section of the digestive system where the gall bladder delivers bile.
• C. It is the section of the small intestine where the pancreas delivers digestive juices.
• D. None of the above.

Correct answer: D

Rationale: The duodenum is the first part of the small intestine, located immediately after the stomach. It is where the majority of digestion takes place in the gut. The pancreas delivers digestive juices containing amylase and lipase, while the gall bladder delivers bile to aid in the digestion of fats. Choice A incorrectly states that the duodenum is the third section of the small intestine, which is inaccurate. Choice B incorrectly associates the duodenum with the gall bladder, which is not where the duodenum is located. Choice C incorrectly states that the duodenum is where the pancreas delivers digestive juices, which is partly correct but not the main function of the duodenum. Therefore, the correct answer is 'None of the above' as none of the choices accurately describe the location or functions of the duodenum.

5. When educating a client about their new prescription for warfarin, what should the nurse advise?

• A. To have his white blood cell count tested once a month
• B. To avoid any activities that could lead to injury
• C. To avoid eating leafy green vegetables
• D. Both A and B

Correct answer: B

Rationale: The correct answer is to advise the client to avoid any activities that could lead to injury when taking warfarin. Warfarin is an anticoagulant medication that decreases blood clotting, increasing the risk of bleeding. Engaging in activities that may result in injury can lead to uncontrolled bleeding, which can be serious. While monitoring white blood cell count is not specifically related to warfarin therapy, avoiding leafy green vegetables is important due to their vitamin K content, which can interfere with warfarin's effectiveness. Therefore, the client should be educated to avoid activities that could cause injury to prevent potential bleeding complications.

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