Nursing Elites

1. A 67-year-old client is admitted with substernal chest pain with radiation to the jaw. His admitting diagnosis is Acute Myocardial Infarction (MI). The priority nursing diagnosis for this client during the immediate 24 hours is

• A. Constipation related to immobility
• B. High risk for infection
• C. Impaired gas exchange
• D. Fluid volume deficit

Correct answer: C

Rationale: The correct answer is C: Impaired gas exchange. In a client with an acute myocardial infarction, impaired gas exchange is a priority nursing diagnosis due to compromised heart function, which affects oxygenated blood circulation. Close monitoring and interventions are crucial to ensure adequate oxygenation. Choices A, B, and D are incorrect: A) Constipation related to immobility is not the priority in this acute situation; B) High risk for infection is not the immediate concern related to the client's primary diagnosis; D) Fluid volume deficit, while important, is not the priority compared to addressing impaired gas exchange in acute MI.

2. The nurse is caring for a child with cystic fibrosis. The nurse would anticipate that the child would be deficient in which vitamins?

• A. B, D, and K
• B. A, D, and K
• C. A, C, and D
• D. A, B, and C

Correct answer: B

Rationale: Children with cystic fibrosis often have difficulty absorbing fat-soluble vitamins (A, D, and K) due to pancreatic insufficiency, making supplementation necessary. Choice A (B, D, and K) is incorrect because vitamin A deficiency is not commonly associated with cystic fibrosis. Choice C (A, C, and D) is incorrect as vitamin C deficiency is not typically related to cystic fibrosis. Choice D (A, B, and C) is incorrect as vitamin B deficiencies are not commonly seen in cystic fibrosis but rather fat-soluble vitamin deficiencies.

3. After 3 days, the nurse notes that James has chest indrawing and stridor. His mother returned him to the health center immediately. The nurse should:

• A. Change the antibiotic to second-line antibiotics
• B. Advise the mother to observe the child and continue giving the antibiotics
• C. Give the first dose of antibiotics and refer urgently
• D. Observe the child at the center

Correct answer: C

Rationale: Chest indrawing and stridor are signs of severe respiratory distress. In this situation, immediate referral is essential. Giving the first dose of antibiotics before referral can help initiate treatment, but urgent referral for further evaluation and management is crucial. Choice A is incorrect because simply changing the antibiotic without assessing the severity of the symptoms and providing urgent care is not appropriate. Choice B is incorrect as advising the mother to observe the child and continue antibiotics delays necessary intervention for a potentially life-threatening condition. Choice D is incorrect as observing the child at the center is not sufficient when signs of severe illness are present.

4. Which playroom activities should the nurse organize for a small group of 7-year-old hospitalized children?

• A. Sports and games with rules
• B. Finger paints and water play
• C. "Dress-up" clothes and props
• D. Chess and television programs

Correct answer: A

Rationale: Sports and games with rules are appropriate for the cognitive development stage of 7-year-olds.

5. Several employees who have a 10-year or longer history of smoking ask the occupational nurse for assistance with smoking cessation. The RN develops a 2-month program that includes weekly group sessions on lifestyle changes and use of OTC products. Which measurement provides the best indication of the program's effectiveness?

• A. Encourage the employees to disclose if they have joined another smoking cessation group.
• B. Ask the employees to inform the group if they stop smoking and if they start back up again.
• C. Survey the employees about their smoking habits.
• D. Observe if the employees are smoking in the designated smoking areas.

Correct answer: C

Rationale: Surveying the employees about their smoking habits provides measurable data on program effectiveness. By collecting data directly from the employees through surveys, the occupational nurse can track changes in smoking habits, frequency, and quantity of cigarettes smoked. This direct feedback allows for a more accurate assessment of the program's impact on smoking cessation. Choices A and B rely on self-disclosure and may not provide reliable or objective data. Choice D does not directly measure changes in smoking habits but rather observes behavior in designated areas, which may not reflect overall smoking cessation progress.

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