Nursing Elites

1. A client in the emergency room enters the care area to start an IV. He finds a man sitting on the table, hunched over, and attempting to take deep breaths. He states, 'my chest hurts so much!' His wife is sitting on a chair in the corner, crying. Which of the following is the first action of the client?

• A. Bring the IV kit and quickly start an IV
• B. Assess his breathing and provide oxygen, if necessary
• C. Administer medication to control chest pain
• D. Talk with his wife and find out why she is crying

Correct answer: B

Rationale: In the above scenario, the first action of the nurse should be to assess the client's airway and breathing. It is crucial to address respiratory status first, as the client appears to be experiencing difficulty breathing. Providing oxygen if necessary can help support oxygenation and alleviate potential respiratory distress. Administering medication for chest pain or starting an IV can come after ensuring adequate oxygenation. Talking with the client's wife, though important for emotional support, is not the priority when the client's respiratory status needs to be assessed and managed promptly.

2. An adolescent brings a physician's note to school stating that he is not to participate in sports due to a diagnosis of Osgood-Schlatter disease. Which of the following statements about the disease is correct?

• A. The condition is not caused by the student's competitive swimming schedule.
• B. The student will most likely not require surgical intervention.
• C. The student experiences pain in the inferior aspect of the knee.
• D. The student is not trying to avoid participation in physical education.

Correct answer: C

Rationale: Osgood-Schlatter disease occurs in adolescents during the rapid growth phase when the infrapatellar ligament of the quadriceps muscle pulls on the tibial tubercle, causing pain and swelling in the inferior aspect of the knee. The condition is commonly caused by activities that require repeated use of the quadriceps, such as track and soccer. Choice A is incorrect because Osgood-Schlatter disease is not specifically linked to competitive swimming. Choice B is incorrect as surgical intervention is not usually necessary for this condition. Choice D is incorrect as the student is not trying to avoid physical education but is restricted from participating in sports due to the diagnosis of Osgood-Schlatter disease.

3. When should discharge training and planning begin for a 65-year-old man admitted to the hospital for spinal stenosis surgery?

• A. Following surgery
• B. Upon admission
• C. Within 48 hours of discharge
• D. Preoperative discussion

Correct answer: B

Rationale: Discharge training and planning should begin upon admission for a patient undergoing spinal stenosis surgery. It is crucial to initiate this process early to ensure a smooth transition from hospital care to home or a rehabilitation facility. Starting discharge planning upon admission allows for comprehensive involvement of the patient, family, and healthcare team, which can reduce the risk of readmission, optimize recovery, ensure proper medication management, and adequately prepare caregivers. Therefore, option B, 'Upon admission,' is the correct answer. Options A, C, and D are incorrect because waiting until after surgery, within 48 hours of discharge, or during preoperative discussion would not provide sufficient time for effective discharge planning and education.

4. In a clinic in a primarily African American community, a higher incidence of uncontrolled hypertension is noted in patients. To correct this health disparity, what should the nurse do first?

• A. Initiate a regular home-visit program by clinic nurses.
• B. Schedule teaching sessions about low-salt diets at community events.
• C. Assess the perceptions of community members about the care at the clinic.
• D. Obtain low-cost antihypertensive drugs using government grant funding.

Correct answer: C

Rationale: To address the higher incidence of uncontrolled hypertension in the primarily African American community, the nurse should first assess the perceptions of community members about the care at the clinic. Understanding the community's perspective can provide valuable insights into the reasons behind the health disparity. Initiating a regular home-visit program or scheduling teaching sessions about low-salt diets are important interventions but should come after gathering information on community perceptions. Obtaining low-cost antihypertensive drugs is not the initial priority; understanding community perspectives is crucial for developing effective interventions.

5. Which of the following types of antipsychotic medications is most likely to produce extrapyramidal effects?

• A. Atypical antipsychotic drugs
• B. First-generation antipsychotic drugs
• C. Third-generation antipsychotic drugs
• D. Dopamine system stabilizers

Correct answer: B

Rationale: The correct answer is first-generation antipsychotic drugs. These drugs are potent antagonists of D2, D3, and D4 receptors, making them effective in treating target symptoms but also leading to numerous extrapyramidal side effects due to the blockade of D2 receptors. Atypical or second-generation antipsychotic drugs, as mentioned in choice A, are relatively weak D2 blockers, which results in a lower incidence of extrapyramidal side effects. Third-generation antipsychotic drugs, as in choice C, and dopamine system stabilizers, as in choice D, are not typically associated with significant extrapyramidal effects compared to first-generation antipsychotics.

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