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. Epidemiology is directly concerned with which of the following?

• A. factors influencing occurrence and distribution of diseases, defects, disability, or death of groups of individuals
• B. vital health statistics
• C. environmental sanitation
• D. treatment of a communicable disease

Correct answer: A

Rationale: Corrected Rationale: Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations and the application of this study to the control of health problems. It focuses on identifying and understanding the factors that influence the occurrence and distribution of diseases, defects, disability, or death of groups of individuals. Therefore, the correct answer is A. Choice B, vital health statistics, is not the primary focus of epidemiology. While vital health statistics may be used in epidemiological studies, it is not the direct concern of epidemiology. Choice C, environmental sanitation, although important for public health, is not the main focus of epidemiology. Epidemiology is more concerned with the factors influencing disease occurrence and distribution, rather than environmental sanitation. Choice D, treatment of a communicable disease, is more related to clinical medicine rather than epidemiology. Epidemiology is more focused on prevention, control, and understanding the patterns and causes of diseases rather than their treatment.

3. Which of these tests with frequency would the nurse expect to monitor for the evaluation of clients with poor glycemic control in persons aged 18 and older?

• A. A glycosylated hemoglobin (A1c) should be performed during an initial assessment and during follow-up assessments, which should occur at no longer than 3-month intervals
• B. A glycosylated hemoglobin should be obtained at least twice a year
• C. A fasting glucose and a glycosylated hemoglobin should be obtained at 3-month intervals after the initial assessment
• D. A glucose tolerance test, a fasting glucose, and a glycosylated hemoglobin should be obtained at 6-month intervals after the initial assessment

Correct answer: A

Rationale: Glycosylated hemoglobin (A1c) testing every 3 months is recommended for clients with poor glycemic control to monitor their average blood sugar levels and adjust treatment as necessary. Choice A is correct as it aligns with the guideline of performing A1c testing every 3 months. Choice B is incorrect because testing at least twice a year may not provide adequate monitoring for clients with poor glycemic control. Choice C is incorrect as it only mentions testing at 3-month intervals without specifying the importance of A1c testing. Choice D is incorrect as it includes unnecessary tests like glucose tolerance test and does not emphasize the importance of more frequent A1c monitoring for clients with poor glycemic control.

4. A client with a fractured femur is in Buck's traction. The nurse should assess for which of the following complications?

• A. Foot drop
• B. Urinary retention
• C. Constipation
• D. Muscle spasms

Correct answer: A

Rationale: Corrected Rationale: Foot drop is a potential complication of prolonged immobility and improper positioning in traction. In Buck's traction, the lower extremity is suspended to immobilize and align the fractured femur. Prolonged suspension of the leg in traction can lead to nerve damage, specifically to the common peroneal nerve, resulting in foot drop. Urinary retention, constipation, and muscle spasms are not directly associated with Buck's traction and a fractured femur.

5. Which intervention should the public health nurse implement to address one of the leading health indicators of Healthy People 2020?

• A. Lead a weekly water aerobics class for the elderly at a community center.
• B. Teach a class on cultural awareness to nursing students at the university.
• C. Design and implement a no smoking campaign at the local high school.
• D. Write a grant to help provide glucometers to individuals who cannot afford one.

Correct answer: C

Rationale: Designing and implementing a no smoking campaign aligns with the objective of reducing tobacco use, which is one of the leading health indicators of Healthy People 2020. This intervention directly targets a significant public health concern. Leading a water aerobics class, teaching cultural awareness, or providing glucometers, while beneficial in other contexts, do not specifically address the leading health indicators outlined by Healthy People 2020.

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