Nursing Elites

1. An alcoholic and homeless patient is diagnosed with active tuberculosis (TB). Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen?

• A. Arrange for a friend to administer the medication on schedule.
• B. Give the patient written instructions about how to take the medications.
• C. Teach the patient about the high risk for infecting others unless treatment is followed.
• D. Arrange for a daily noon meal at a community center where the drug will be administered

Correct answer: D

Rationale: Directly observed therapy is the most effective means for ensuring compliance with the treatment regimen for a homeless patient with active tuberculosis. By arranging a daily noon meal at a community center where the drug will be administered, the nurse ensures that the patient is available to receive the medication and can directly observe the patient taking it. This method helps address the challenges faced by homeless individuals, such as lack of a stable living situation. The other options, such as having a friend administer the medication, giving written instructions, or educating about infecting others, may not be as effective in ensuring adherence, especially in the case of a homeless individual with alcoholism.

2. The nurse reviews the record of a child who is suspected to have glomerulonephritis and expects to note which finding that is associated with this diagnosis?

• A. Hypotension
• B. Brown-colored urine
• C. Low urinary specific gravity
• D. Low blood urea nitrogen level

Correct answer: B

Rationale: Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Gross hematuria resulting in dark, smoky, cola-colored, or brown-colored urine is a classic symptom of glomerulonephritis. Hypertension is also common. Blood urea nitrogen levels may be elevated. A moderately elevated to high urinary specific gravity is associated with glomerulonephritis.

3. The nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record?

• A. Incessant crying
• B. Coughing at nighttime
• C. Choking with feedings
• D. Severe projectile vomiting

Correct answer: C

Rationale: In esophageal atresia and tracheoesophageal fistula, the esophagus ends before it reaches the stomach, forming a blind pouch, and there is an abnormal connection (fistula) with the trachea. Any child who exhibits the '3 Cs'"?coughing and choking with feedings and unexplained cyanosis"?should be suspected to have tracheoesophageal fistula. Option A, 'Incessant crying,' is not a typical sign of esophageal atresia with tracheoesophageal fistula. Option B, 'Coughing at nighttime,' is not a specific sign associated with this condition. Option D, 'Severe projectile vomiting,' is not a common sign of esophageal atresia with tracheoesophageal fistula.

4. The nurse is performing a neurological assessment on a client post right cerebrovascular accident. Which finding, if observed by the nurse, would warrant immediate attention?

• A. Decrease in level of consciousness
• B. Loss of bladder control
• C. Altered sensation to stimuli
• D. Emotional lability

Correct answer: A

Rationale: A decrease in the level of consciousness is a critical finding that would warrant immediate attention in a client post right cerebrovascular accident. This change may indicate an increase in intracranial pressure, leading to inadequate oxygenation of the brain. It could also reveal the presence of a transient ischemic attack, which may signal an impending thrombotic cerebrovascular accident. Loss of bladder control (choice B) can be managed and monitored but does not indicate an immediate threat to the client's life. Altered sensation to stimuli (choice C) can be a concerning finding but may not require immediate attention unless it affects the client's safety. Emotional lability (choice D) may be distressing for the client but does not pose an immediate risk to their health compared to a decrease in the level of consciousness.

5. What action will the nurse plan to take for a 40-year-old patient with multiple sclerosis (MS) who has urinary retention caused by a flaccid bladder?

• A. Decrease the patient's evening fluid intake.
• B. Teach the patient how to use the Cred method.
• C. Suggest the use of adult incontinence briefs for nighttime only.
• D. Assist the patient to the commode every 2 hours during the day.

Correct answer: B

Rationale: For a 40-year-old patient with multiple sclerosis experiencing urinary retention due to a flaccid bladder, teaching the Cred method is the appropriate action. The Cred method involves applying manual pressure over the bladder to aid in bladder emptying. Decreasing fluid intake is not the correct approach as it will not address the underlying issue of bladder emptying and may lead to dehydration and urinary tract infections. Using adult incontinence briefs only addresses the symptom of incontinence without addressing the bladder emptying problem. Assisting the patient to the commode every 2 hours does not actively address the issue of improving bladder emptying as effectively as teaching the Cred method.

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