Nursing Elites

1. A child comes to the clinic with a skin rash. The maculopapular lesions are distributed around the mouth and have honey-colored drainage. The caregiver states that the rash is getting worse and seems to spread with the child's scratching. Which of the following advisory comments should be given?

• A. The history and presentation might indicate chickenpox, a highly contagious disease.
• B. The lesions might indicate a noncontagious infection that does not require isolation.
• C. The history and presentation might indicate an infectious illness called impetigo.
• D. The lesions are not contagious unless others have open wounds or lesions themselves.

Correct answer: C

Rationale: The scenario describes classic impetigo, which typically presents with maculopapular lesions around the mouth with honey-colored drainage, worsening with scratching. It is important to advise the caregiver that the history and presentation are indicative of impetigo, an infectious skin condition caused by bacteria. Treatment usually involves antibiotic therapy. Choice A is incorrect because chickenpox typically presents with a vesicular rash following a history of high fever. Choice B is incorrect as impetigo is contagious and requires precautions to prevent the spread of infection. Choice D is incorrect as impetigo is contagious irrespective of open wounds or lesions in others.

2. Priorities designated as intermediate by the nurse are:

• A. the nonemergency, non-life-threatening needs of the client.
• B. those tasks that can be delegated to assistive personnel.
• C. those tasks that can be performed at the end of the shift.
• D. those tasks that can be performed at any time

Correct answer: A

Rationale: Priorities designated as intermediate by the nurse are those that are not urgent but still important, such as the nonemergency, non-life-threatening needs of the client. They do not impact the client's immediate physiological status but require attention. Intermediate priorities may need the skill level of an RN for completion and may have specific time requirements. Choices B, C, and D are incorrect because the priority being intermediate doesn't mean it can be delegated, done at a specific time, or done at any time; it simply indicates a non-urgent but necessary task for the client's well-being.

3. A client has been placed in isolation because he is diagnosed with a contagious illness. The nurse should be aware that:

• A. Linens from the client's bed should be double-bagged.
• B. Meals should be served on washable dishes.
• C. Extensive isolation rarely causes psychological problems.
• D. Paper trays and plastic utensils do not prevent disease transmission.

Correct answer: A

Rationale: Isolation techniques are used to prevent or limit the spread of infection. Special handling of articles and linens soiled by any body fluid is essential. Linens should be placed in impervious bags before being removed from the client's bedside to prevent exposure of personnel and contamination of the environment. Double-bagging is required if the outside of the bag becomes contaminated. This practice ensures that potentially infectious materials are properly contained and disposed of. Choices B, C, and D are incorrect because the focus in this scenario is on proper handling and disposal of soiled linens to prevent the spread of infection, not on serving meals, psychological effects of isolation, or the use of paper trays and plastic utensils.

4. Following a recent tattoo, someone should be screened for:

• A. tuberculosis.
• B. herpes.
• C. hepatitis.
• D. syphilis.

Correct answer: C

Rationale: Following a recent tattoo, someone should be screened for hepatitis. Tattooing puts a client at risk for blood-borne hepatitis B or C if strict sterile procedures are not followed. Tuberculosis is an airborne pathogen, while herpes and syphilis are spread through direct contact like sexual activity. Therefore, hepatitis is the most relevant infection to screen for after getting a tattoo.

5. An LPN is talking with a client scheduled to undergo a vasectomy in the next few minutes. He states, "I know I signed the form and all, but I'm not feeling so sure of this. It can be reversed pretty easily, right?"? What is the LPN's best response?

• A. "Yes, vasectomies can be reversed, but once you have it, you may regret it later."?
• B. "It's normal to feel a little nervous before a procedure like this."?
• C. "It sounds like you have a few more questions you'd like answered. Let me grab the doctor quickly so he can answer them for you."?
• D. "It sounds like you might be a little nervous. Don't worry, this is a pretty minor procedure, and the doctor doing it is the best we have. You're in great hands."?

Correct answer: C

Rationale: The best response for the LPN is to acknowledge the client's concerns and offer to provide more information. By offering to get the doctor to answer any additional questions, the LPN shows respect for the client's right to informed consent. Option A provides some information but dismisses the client's uncertainty and implies they won't regret the decision, which may not be the case. Option B acknowledges nervousness but doesn't directly address the client's request for more information. Option D attempts to reassure the client but fails to address the need for additional questions to be answered by the doctor.

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