Nursing Elites

1. You are caring for an infant who is just about 12 months old. Which assessment data is normal for the infant at this age?

• A. The infant had doubled their birth weight at twelve months.
• B. The infant had tripled their birth weight at twelve months.
• C. The mother reports that the infant is drinking 60 mLs per kilogram of its body weight.
• D. The infant had grown � inch since last month.

Correct answer: A

Rationale: The normal assessment data for the infant at 12 months of age is that the infant has doubled their birth weight at 12 months of age. The mother's reports that the infant is drinking 60 mLs per kilogram of its body weight and the fact that the infant had grown � inch since last month are not normal assessment data. Infants are fed breast milk or formula every two to four hours with a total daily intake of 80 to 100 mLs per kilogram of body weight. As the neonate grows, they gain five to seven ounces during the first six months and then they double their birth weight during the first year; the head circumference increases a half inch each month for six months and then two tenths of an inch until the infant is one year of age. Similarly, the height or length of the newborn increases an inch a month for the first 6 months and then 1/2 inch a month until the infant is 1 year of age.

2. Is it true that Hepatitis C virus (HCV) can be spread through hugging, sneezing, coughing, sharing eating utensils, and other forms of casual contact?

• A. True
• B. False
• C.
• D.

Correct answer: B

Rationale: False. HCV is not spread through casual contact such as hugging, sneezing, or sharing eating utensils. The correct modes of transmission for HCV include direct contact with human blood through blood transfusions, improperly sterilized needles and syringes, needle sharing, or occasionally through sexual contact. Therefore, the statement is false, making 'False' the correct answer. Choices A, C, and D are incorrect as they do not accurately reflect the mode of transmission of HCV.

3. A client is discharged following hospitalization for congestive heart failure. The nurse teaching the family suggests they encourage the client to rest frequently in which of the following positions?

• A. High Fowler's
• B. Supine
• C. Left lateral
• D. Low Fowler's

Correct answer: A

Rationale: The correct answer is "High Fowler's" position. Sitting in a chair or resting in a bed in a high Fowler's position decreases the cardiac workload and facilitates breathing. This position helps reduce the work of breathing and promotes optimal lung expansion, making it easier for the client to breathe. Supine position (choice B) is lying flat on the back and may not be ideal for clients with congestive heart failure as it can increase pressure on the heart. Left lateral position (choice C) is commonly used for promoting circulation in clients with certain conditions but is not the most appropriate for congestive heart failure. Low Fowler's position (choice D) is not recommended as it does not provide the same benefits in terms of reducing cardiac workload and easing breathing as the high Fowler's position.

4. Choose the BEST answer. To ensure adequate protection for legal issues, offices should maintain patients' charts for:

• A. 10 years
• B. Forever
• C. Until the age of majority
• D. 2 years after the patient was last seen in the office

Correct answer: B

Rationale: The correct answer is 'Forever.' Maintaining patients' charts indefinitely ensures comprehensive legal protection by having all relevant information available in case of litigation or if patient history needs to be referenced in the future. Choice A, '10 years,' may not be sufficient to cover the entire period within which legal issues may arise. Choice C, 'Until the age of majority,' is not ideal as legal matters may extend beyond this age limit. Choice D, '2 years after the patient was last seen in the office,' is inadequate as legal actions can occur beyond this timeframe, necessitating the need for long-term retention of patient charts.

5. Teresa is an 84-year-old with stage 4 ovarian cancer who has been admitted for a bowel obstruction. She recently stated that she has decided that she doesn't want any further aggressive care and is requesting to be placed under hospice care. Her husband and daughter are supportive of her decision. She spoke with her oncologist about it, and he stated that he did not agree and wrote orders on her chart for chemotherapy. What would be the best first response to this situation?

• A. Give the patient a list of other oncologists
• B. Tell the family to report the doctor to the state quality board
• C. Notify the doctor that the patient refuses the chemotherapy
• D. Give the patient hospice information

Correct answer: C

Rationale: The patient has the right to refuse any treatment, and the doctor should be notified that the orders on the chart cannot be performed, with appropriate documentation. In this situation, the best first response is to notify the doctor that the patient refuses the chemotherapy. This step ensures that the patient's wishes are respected and that inappropriate treatments are not administered. It also opens up a dialogue with the oncologist, giving him the opportunity to understand the patient's perspective and potentially support her decision. Providing hospice information is a good follow-up step after addressing the immediate issue of refusing chemotherapy, as it allows the patient to initiate her own hospice evaluation if desired. Giving the patient a list of other oncologists or telling the family to report the doctor to the state quality board are not appropriate initial responses and may not align with the patient's wishes or autonomy.

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