Nursing Elites

1. When assessing the respiratory system of an older patient, which finding indicates that the nurse should take immediate action?

• A. Weak cough effort
• B. Barrel-shaped chest
• C. Dry mucous membranes
• D. Bilateral crackles at lung bases

Correct answer: D

Rationale: Bilateral crackles at lung bases indicate a potential acute issue like heart failure. Immediate action is necessary in this situation. The nurse should conduct further assessments such as oxygen saturation and inform the healthcare provider promptly. A barrel-shaped chest and hyperresonance to percussion are typical signs of aging and do not require immediate action. A weak cough effort is common in older patients due to age-related changes, and dry mucous membranes are also expected in older individuals. While these findings may warrant further evaluation, they do not demand immediate action like bilateral crackles at lung bases.

2. When caring for a patient with Parkinson's Disease, which of the following practices would not be included in the care plan?

• A. Decrease the calorie content of daily meals to avoid weight gain
• B. Allow the patient extra time to respond to questions and perform ADLs
• C. Use thickened liquids and a soft diet
• D. Encourage the patient to hold the spoon when eating

Correct answer: A

Rationale: The correct answer is to decrease the calorie content of daily meals to avoid weight gain. Patients with Parkinson's Disease often experience dysphagia (difficulty swallowing) and muscle rigidity, which can lead to weight loss. Therefore, increasing calorie intake is essential to meet their nutritional needs. Choice A is incorrect because reducing calories can worsen malnutrition in these patients. Choices B, C, and D are appropriate interventions for patients with Parkinson's Disease. Allowing extra time for tasks, using thickened liquids and a soft diet for swallowing difficulties, and encouraging self-feeding promote independence and safety in eating.

3. Mr. V is receiving treatment for a spinal cord injury after falling off of his deck at home. He has undergone spinal surgery and has been placed in a halo traction device. Which of the following nursing interventions is most appropriate for a client with a spinal cord injury?

• A. Turn the client and use incentive spirometry each shift
• B. Administer stool softeners as ordered
• C. Turn the head slowly to avoid further damage to the spine
• D. Change NPO status

Correct answer: B

Rationale: In a client with a spinal cord injury, administering stool softeners as ordered is a crucial nursing intervention. Patients with spinal cord injuries are at higher risk of constipation due to decreased mobility. Stool softeners help prevent constipation and potential fecal impaction. Turning the client and using incentive spirometry each shift can be beneficial for respiratory function but is not the most vital intervention in this scenario. Turning the head slowly to avoid further damage to the spine is important but is not directly related to preventing constipation. Changing NPO status is not relevant to preventing constipation or managing a spinal cord injury.

4. Which action will be included in the care for a patient who has recently been diagnosed with asymptomatic nonalcoholic fatty liver disease (NAFLD)?

• A. Teach about symptoms of variceal bleeding
• B. Draw blood for hepatitis serology testing
• C. Discuss the need to increase caloric intake
• D. Review the patient's current medication list

Correct answer: D

Rationale: The correct action for a patient diagnosed with asymptomatic nonalcoholic fatty liver disease (NAFLD) would be to review the patient's current medication list. This is important because certain medications can increase the risk for NAFLD, and they should be identified and possibly eliminated. Teaching about symptoms of variceal bleeding is not necessary as variceal bleeding is not a concern in a patient with asymptomatic NAFLD. Drawing blood for hepatitis serology testing is not indicated as NAFLD is not associated with hepatitis. Discussing the need to increase caloric intake is also not appropriate since weight loss is usually recommended in the management of NAFLD.

5. In a pediatric clinic, a nurse is assessing a child recently diagnosed with cystic fibrosis. Which of the following later findings of this disease would the nurse not expect to see at this time?

• A. Positive sweat test
• B. Bulky greasy stools
• C. Moist, productive cough
• D. Meconium ileus

Correct answer: C

Rationale: In a child newly diagnosed with cystic fibrosis (CF), noisy respirations and a dry, non-productive cough are typically the first respiratory signs to appear. The other options, including a positive sweat test, bulky greasy stools, and meconium ileus, are among the earliest findings of CF. CF is a genetic condition that affects the production of mucus, sweat, saliva, and digestive juices. Due to a defective gene, these secretions become thick and sticky instead of thin and slippery, leading to blockages in various passageways, especially in the pancreas and lungs. Respiratory failure is a severe consequence of CF, making it crucial to monitor respiratory symptoms closely in affected individuals. Therefore, a moist, productive cough would not be an expected finding in a newly diagnosed child with CF.

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