Nursing Elites

1. Which entry in the medical record best meets the requirement for problem-oriented charting?

• A. "A: Pacing and muttering to self. P: Sensory perceptual alteration, related to internal auditory stimulation. I: Given fluphenazine (Prolixin) 2.5 mg at 0900, and went to room to lie down. E: Calmer by 0930. Returned to lounge to watch TV."?
• B. "S: States, 'I feel like I'm ready to blow up.' O: Pacing hall, mumbling to self. A: Auditory hallucinations. P: Offer haloperidol (Haldol) 2 mg . I: (Haldol) 2 mg at 0900. E: Returned to lounge at 0930 and quietly watched TV."?
• C. "Agitated behavior. D: Patient muttering to self as though answering an unseen person. A: Given haloperidol (Haldol) 2 mg and went to room to lie down. E: Patient calmer. Returned to lounge to watch TV."?
• D. "Pacing hall and muttering to self as though answering an unseen person. haloperidol (Haldol) 2 mg administered at 0900 with calming effect in 30 minutes. Stated, 'I'm no longer bothered by the voices.'"?

Correct answer: B

Rationale: Problem-oriented documentation uses the first letter of key words to organize data: S for subjective data, O for objective data, A for assessment, P for plan, I for intervention, and E for evaluation. The correct answer demonstrates problem-oriented charting by following this structure. Choice A, C, and D do not follow the problem-oriented charting format and instead offer examples of different documentation styles such as PIE charting, focus documentation, and narrative documentation, respectively. Therefore, choice B is the best example of problem-oriented charting among the options provided.

2. The major difference between a grand mal and petit mal seizure is that a person with a grand mal seizure will have _______________ and the person with a petit mal seizure will not.

• A. convulsive movements
• B. sleep apnea
• C. atonic movements
• D. flaccidity

Correct answer: A

Rationale: The major difference between a grand mal and petit mal seizure is the presence or absence of convulsive movements. Grand mal seizures are characterized by convulsive movements, including jerking of limbs and loss of consciousness. In contrast, petit mal seizures, also known as absence seizures, typically involve brief episodes of staring or eye blinking without convulsive movements. Therefore, choice A, 'convulsive movements,' is the correct answer. Choices B, 'sleep apnea,' and D, 'flaccidity,' are incorrect as they are not associated with the characteristics of grand mal or petit mal seizures. Choice C, 'atonic movements,' is also incorrect as petit mal seizures do not involve atonic movements, but rather absence behaviors such as staring spells.

3. Which of the following glands found in the skin secretes a liquid called Sebum?

• A. Apocrine Glands
• B. Sebaceous Glands
• C. Lacrimal Glands
• D. Sweat Glands

Correct answer: B

Rationale: Sebum is a liquid secreted by glands in the skin known as sebaceous glands. Sebum's primary function is to lubricate the skin and help maintain its integrity. Apocrine glands secrete a different type of sweat that is odorless but can develop an odor when combined with bacteria on the skin. Lacrimal glands produce tears to keep the eyes moist, and sweat glands secrete sweat to regulate body temperature through evaporation. Therefore, the correct answer is Sebaceous Glands because they specifically secrete sebum, distinguishing them from the other gland types mentioned.

4. A patient in the cardiac care unit is taking bumetanide (Bumex) for heart issues and is also diagnosed with Parkinson's Disease. An unlicensed assistive personnel is assisting with feeding the patient. Which of these foods should the nurse stress for the patient to eat most?

• A. Foods containing the least amount of salt
• B. Foods containing the most amount of potassium
• C. Foods containing the most amount of calories
• D. Foods containing the most amount of fiber

Correct answer: B

Rationale: Bumex is a loop diuretic that can lead to hypokalemia (low potassium levels). Hypokalemia can be dangerous and lead to various complications. To prevent a hypokalemic crisis, it is crucial to ensure an adequate intake of potassium. Therefore, the nurse should stress the patient to eat foods rich in potassium. Choices A, C, and D are not the priority in this situation. While monitoring salt intake is important in cardiac patients, the immediate concern with bumetanide use is the risk of hypokalemia, making choice B the most appropriate option.

5. What is the likely cause of pericarditis in a young patient?

• A. Heart failure
• B. Acute MI
• C. Hypertension
• D. Infectious processes

Correct answer: D

Rationale: In younger patients, pericarditis is typically caused by an infection commonly triggered by viruses like the Coxsackie virus, streptococcus, staphylococcus, or Haemophilus influenzae. Infectious processes are the leading cause of pericarditis in younger individuals. Heart failure, Acute MI, and Hypertension are not common causes of pericarditis in young patients. In older adults, acute myocardial infarction (MI) is a more common cause of pericarditis.

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