Nursing Elites

1. What instruction should the nurse provide a pregnant client experiencing heartburn?

• A. Limit fluid intake between meals to prevent stomach over-distension
• B. Take an antacid at bedtime and when symptoms worsen
• C. Maintain an upright position for two hours after eating
• D. Eat small meals throughout the day to avoid a full stomach

Correct answer: D

Rationale: The correct answer is D: 'Eat small meals throughout the day to avoid a full stomach.' Heartburn is common in pregnancy due to increased intra-abdominal pressure and hormonal changes. Consuming small, frequent meals prevents the stomach from becoming overly full, reducing the likelihood of acid reflux and heartburn. Choice A is incorrect because limiting fluid intake between meals may not significantly impact heartburn. Choice B is not ideal as antacids should be taken as directed by a healthcare provider, not just at bedtime or when symptoms worsen. Choice C is less effective advice, as maintaining an upright position after eating may not directly address the root cause of heartburn.

2. An older male was recently admitted to the rehabilitation unit with unilateral neglect syndrome as a result of a cerebrovascular accident (CVA). Which action should the nurse include in the plan of care?

• A. Provide additional light in the room to promote sensory stimulation
• B. Teach the client to turn his head from side to side for visual scanning
• C. Place a clock and calendar in the room to improve orientation
• D. Use hand and arm gestures to improve communication and comprehension

Correct answer: B

Rationale: Teaching the client to turn his head from side to side for visual scanning is essential in addressing unilateral neglect syndrome caused by a cerebrovascular accident. This action helps improve visual awareness and assists the client in overcoming the neglect of one side of the body. Providing additional light for sensory stimulation (Choice A) may not directly address the issue of unilateral neglect. Placing a clock and calendar in the room (Choice C) may be helpful for orientation but does not specifically target unilateral neglect. Using hand and arm gestures for communication (Choice D) may aid in communication but does not directly address the visual scanning deficits associated with unilateral neglect syndrome.

3. A newly hired unlicensed assistive personnel (UAP) is assigned to a home healthcare team along with two experienced UAPs. Which intervention should the home health nurse implement to ensure adequate care for all clients?

• A. Ask the most experienced UAP on the team to partner with the newly hired UAP.
• B. Evaluate the newly hired UAP’s level of competency by observing the UAP deliver care.
• C. Review the UAP’s skills checklist and experience with the person who hired the UAP.
• D. Assign the newly hired UAP to clients who require the least complex level of care.

Correct answer: B

Rationale: Evaluating the newly hired UAP’s competency by observing them deliver care is the most effective intervention to ensure they can provide safe and effective care. This approach directly assesses the UAP's actual performance and allows for immediate feedback. Option A, asking the most experienced UAP to partner with the newly hired one, may not guarantee that the new UAP is competent. Option C, reviewing the UAP’s skills checklist and experience with the hiring person, does not provide a direct assessment of the UAP's current abilities. Option D, assigning the new UAP to less complex cases, does not address the need to evaluate their competency directly.

4. A young adult woman visits the clinic and learns that she is positive for BRCA1 gene mutation and asks the nurse what to expect next. How should the nurse respond?

• A. Explain that counseling will be provided to give her information about her cancer risk.
• B. Gather additional information about the client’s family history for all types of cancer.
• C. Offer assurance that there are a variety of effective treatments for breast cancer.
• D. Provide information about survival rates for women who have this genetic mutation.

Correct answer: A

Rationale: The correct answer is A because counseling will help the woman understand her risk and options for surveillance or preventive measures. At this point, it is crucial to address the woman's immediate concerns related to the BRCA1 gene mutation. Choice B is incorrect as the focus should be on the woman's individual risk due to the specific gene mutation she carries. Choice C is not the priority as treatment options come after assessing the risk and deciding on surveillance or preventive measures. Choice D is incorrect because discussing survival rates is not the immediate need for someone who has just received information about having a genetic mutation.

5. Which situation is a violation of client confidentiality, as described in the Health Insurance Portability and Accountability Act (HIPAA)?

• A. A sign-in sheet kept at the front desk listing clients' last names and the time of their arrival
• B. A nurse's handwritten notes from a telephone report discarded in the office wastebasket
• C. A computer monitor screen located at the nurse's station in a high-traffic area
• D. Privileged Health Information (PHI) given to an ambulance driver for the transfer of a client

Correct answer: C

Rationale: Choice C is a violation of client confidentiality as it exposes patient information to unauthorized individuals due to its location in a high-traffic area. HIPAA regulations require that electronic protected health information (ePHI) be safeguarded against unauthorized access, making the situation described in choice C a violation. Choices A, B, and D do not directly involve the exposure of patient information to unauthorized individuals. While choices A and B may pose some risks, they are not as severe as the direct exposure described in choice C. Choice D involves sharing information with an ambulance driver for a legitimate purpose, which does not violate HIPAA if done securely and in compliance with regulations.

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