Nursing Elites

1. After an unimmunized individual is exposed to hepatitis B through a needle-stick injury, which actions will the nurse plan to take (select one that does not apply)?

• A. Administer hepatitis B vaccine.
• B. Test for antibodies to hepatitis B.
• C. Teach about alpha-interferon therapy.
• D. Give hepatitis B immune globulin.

Correct answer: C

Rationale: In the case of exposure to hepatitis B, the nurse should plan to administer hepatitis B vaccine to provide active immunity. Testing for antibodies to hepatitis B is essential to determine the individual's immune status. Giving hepatitis B immune globulin is necessary for passive immunity in cases of exposure. However, teaching about alpha-interferon therapy is not part of the standard management for hepatitis B exposure. Interferon therapy and oral antivirals are typically used in the treatment of chronic hepatitis B infections, not for prophylaxis after exposure.

2. When caring for an asthmatic patient with an early-phase reaction, which of the following is indicative of an early-phase reaction?

• A. Rapid bronchospasms
• B. Inflammatory epithelial lesions
• C. Increased secretions
• D. Increased mucosal edema

Correct answer: A

Rationale: Rapid bronchospasms are a symptom of an early-phase reaction in an asthmatic patient. During the early phase, bronchospasms occur due to immediate hypersensitivity reactions. Inflammatory epithelial lesions, increased secretions, and increased mucosal edema are typically seen in late-phase reactions as part of the inflammatory response that occurs later. Therefore, rapid bronchospasms are most indicative of an early-phase reaction.

3. During an admission assessment on a 2-year-old child diagnosed with nephrotic syndrome, the nurse notes that which characteristic is most commonly associated with this syndrome?

• A. Hypertension
• B. Generalized edema
• C. Increased urinary output
• D. Frank, bright red blood in the urine

Correct answer: B

Rationale: Nephrotic syndrome in children is characterized by massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema. The most common manifestation is generalized edema due to protein loss in the urine, leading to decreased plasma oncotic pressure. This results in fluid shifting into the interstitial spaces, causing edema. Hypertension is not a typical feature of nephrotic syndrome in children. Increased urinary output is not a common finding; instead, children with nephrotic syndrome often have decreased urine output due to decreased renal perfusion. The presence of frank, bright red blood in the urine is not a typical characteristic of nephrotic syndrome but may indicate a different renal condition such as glomerulonephritis.

4. A patient is getting discharged from a skilled nursing facility (SNF). The patient has a history of severe COPD and PVD. The patient is primarily concerned about his ability to breathe easily. Which of the following would be the best instruction for this patient?

• A. Deep breathing techniques to increase oxygen levels.
• B. Cough regularly and deeply to clear airway passages.
• C. Cough following bronchodilator utilization.
• D. Decrease CO2 levels by increasing oxygen intake during meals.

Correct answer: C

Rationale: The correct answer is to instruct the patient to cough following bronchodilator utilization. In COPD and PVD patients, bronchodilators help to open up the airways, making coughing more effective in clearing secretions from the lungs. This instruction can aid in improving the patient's ability to breathe by enhancing airway clearance. Deep breathing techniques (Choice A) may help increase oxygen levels but may not directly address the patient's immediate concern of breathing difficulty. Coughing regularly and deeply (Choice B) can be beneficial, but the timing following bronchodilator use is more crucial to maximize its effectiveness. Decreasing CO2 levels by increasing oxygen intake during meals (Choice D) does not directly address the patient's concern about breathing ease or the role of bronchodilators in improving cough effectiveness.

5. A healthcare professional is reviewing a patient's chart and notices that the patient suffers from Lyme disease. Which of the following microorganisms is related to this condition?

• A. Borrelia burgdorferi
• B. Streptococcus pyogenes
• C. Bacillus anthracis
• D. Enterococcus faecalis

Correct answer: A

Rationale: Lyme disease, the most common vector-borne disease in the United States, is caused by the bacterium Borrelia burgdorferi. Borrelia burgdorferi is transmitted to humans through the bite of infected black-legged ticks. Streptococcus pyogenes is associated with strep throat and other infections, not Lyme disease. Bacillus anthracis causes anthrax, a separate infectious disease. Enterococcus faecalis is more commonly linked to urinary tract infections and other healthcare-associated infections, not Lyme disease.

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