Nursing Elites

1. An occupational health nurse works at a manufacturing plant where there is potential exposure to inhaled dust. Which action, if recommended by the nurse, will be most helpful in reducing the incidence of lung disease?

• A. Treat workers with pulmonary fibrosis.
• B. Teach about symptoms of lung disease.
• C. Require the use of protective equipment.
• D. Monitor workers for coughing and wheezing.

Correct answer: C

Rationale: Prevention of lung disease requires the use of appropriate protective equipment such as masks to reduce exposure to inhaled dust, which is a significant risk factor for lung disease. Teaching about symptoms of lung disease, treating workers with pulmonary fibrosis, and monitoring for coughing and wheezing are important actions for early recognition and treatment of lung disease. However, the most effective strategy to prevent lung damage in this scenario is to require the use of protective equipment to minimize exposure to harmful substances.

2. Gio told his nurse that the FBI is monitoring and recording his every movement and that microphones have been placed in the unit walls. Which action would be the most therapeutic response?

• A. Confront the delusional material directly by telling Gio that this simply is not so.
• B. Tell Gio that this must seem frightening to him but that you believe he is safe here.
• C. Tell Gio to wait and talk about these beliefs in his one-on-one counseling sessions.
• D. Isolate Gio when he begins to talk about these beliefs.

Correct answer: B

Rationale: The most therapeutic response in this situation is to acknowledge Gio's feelings of fear and validate his experience by expressing empathy ('this must seem frightening to him'). By reassuring Gio that he is safe in the current environment, the nurse can help reduce his anxiety and build trust. Choice A is not recommended as directly confronting delusional beliefs may lead to increased distress and resistance. Choice C delays addressing Gio's concerns and may not provide immediate support. Choice D of isolating Gio can worsen his feelings of paranoia and distrust in the treatment setting.

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. Which of the following conditions increases a client's risk of aspiration of stomach contents?

• A. A client is in restraints
• B. A client has a scaphoid abdomen
• C. A client is lying prone
• D. More than one answer is correct

Correct answer: A

Rationale: A client in restraints is at an increased risk of aspiration of stomach contents. When a client is restrained, they may be unable to effectively move or turn their body if they begin to vomit, which can lead to aspiration. This lack of mobility can hinder their ability to protect their airway. On the other hand, a scaphoid abdomen, which is sunken or hollowed, is not a direct risk factor for aspiration. Additionally, lying prone, facing downward, does not necessarily increase the risk of aspiration, as aspiration is more likely when lying supine (facing upward). Therefore, the correct answer is that a client is in restraints.

5. A physician is explaining a procedure to a patient that may cure her recurring Staph infection. The doctor explains how the procedure is done, what to expect, the odds of the procedure curing the infection, and possible side effects and risks. The physician is:

• A. Preparing the patient to give informed consent.
• B. Protecting HIPAA by listing all the steps of the procedure with the risks involved.
• C. Not required to inform the patient of any alternative therapies.
• D. None of the above.

Correct answer: A

Rationale: The correct answer is preparing the patient to give informed consent. Giving informed consent is the process of providing a patient with all necessary information about a medical procedure, including how it's done, what to expect, the likelihood of success, and potential risks and side effects. This allows the patient to make an informed decision about their treatment. Protecting HIPAA (Health Insurance Portability and Accountability Act) involves safeguarding patient health information and is not directly related to the scenario described. It is important for physicians to inform patients of any alternative therapies available to them to ensure they have all relevant information to make a decision regarding their treatment. Therefore, choice C, 'Not required to inform the patient of any alternative therapies,' is incorrect. Choice D, 'None of the above,' is incorrect as the physician is indeed preparing the patient for informed consent.

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