Nursing Elites

1. A community hit by a hurricane has suffered mass destruction and flooding. Several facilities are not functioning, and the area is contaminated with human excretions. The nurse is developing a plan of care for clients diagnosed with cholera after an outbreak. Which intervention has the highest priority?

• A. Administer prophylactic antibiotics as prescribed.
• B. Provide fluid and electrolyte replacement.
• C. Isolate all infectious diarrhea victims.
• D. Administer cholera vaccine.

Correct answer: B

Rationale: Providing fluid and electrolyte replacement is the highest priority to prevent dehydration and shock in clients with cholera. Administering prophylactic antibiotics may be necessary but is not the highest priority. Isolating infectious diarrhea victims is important for preventing the spread of infection, but addressing fluid and electrolyte imbalances takes precedence. Administering a cholera vaccine is preventive and not the immediate priority in treating clients already diagnosed with cholera.

2. Following a bout of diarrhea, which foods should be offered to the school-age child?

• A. Apricots and peaches
• B. Chocolate milk
• C. Applesauce and milk
• D. Bananas and rice

Correct answer: D

Rationale: After rehydration, it is important to offer foods that are nonirritating to the bowel to the child. Bananas and rice are considered the best options as they are least likely to irritate the gastrointestinal tract. Apricots, peaches, and applesauce are fruits that may cause GI irritation, while milk, including chocolate milk, can also be irritating to the bowel. Therefore, the optimal choice for a child recovering from diarrhea would be bananas and rice.

3. An unlicensed assistive personnel (UAP) reports to the nurse that a client with a postoperative wound infection has a temperature of 103.8°F, blood pressure 90/70, pulse 124 beats/min, and respirations of 28 breaths/min. When the nurse assesses the client's findings, they include a mottled skin appearance and confusion. Which action should the nurse take first?

• A. Obtain a wound specimen for culture.
• B. Initiate an infusion of intravenous (IV) fluids.
• C. Transfer the client to the ICU.
• D. Assess the client's core temperature.

Correct answer: B

Rationale: The correct action for the nurse to take first is to initiate an infusion of intravenous (IV) fluids. In this scenario, the client is showing signs of sepsis, indicated by a high temperature, low blood pressure, rapid heart rate, and increased respiratory rate. Mottled skin appearance and confusion are also signs of poor perfusion. Initiating IV fluids is crucial in treating sepsis to maintain blood pressure and perfusion. Obtaining a wound specimen for culture (Choice A) can be important but is not the priority at this moment. Transferring the client to the ICU (Choice C) can be considered after stabilizing the client. Assessing the client's core temperature (Choice D) is not the immediate priority compared to addressing the signs of sepsis and poor perfusion.

4. A child has developed a diaper rash, and the parents are using zinc oxide to treat it. What does the nurse suggest to aid in the removal of the zinc oxide?

• A. Mild soap and water
• B. A cotton ball
• C. Mineral oil
• D. Alcohol swabs

Correct answer: C

Rationale: To completely remove ointment, especially zinc oxide, mineral oil should be used. Mineral oil helps in gently breaking down and lifting the ointment without causing irritation. Mild soap and water (Choice A) may not be effective in completely removing zinc oxide. A cotton ball (Choice B) may not provide the necessary lubrication to aid in the removal process. Alcohol swabs (Choice D) can be harsh on the skin and are not recommended for this purpose.

5. After hospitalization for SIADH, a client develops pontine myelinolysis. Which intervention should the nurse implement first?

• A. Reorient the client to the room
• B. Place an eye patch on one eye
• C. Evaluate the client's ability to swallow
• D. Perform range of motion exercises

Correct answer: C

Rationale: Evaluating the client's ability to swallow is the priority intervention in this scenario. Pontine myelinolysis can affect neurological functions, including swallowing ability, putting the client at risk for aspiration. Assessing the client's ability to swallow will help prevent complications such as aspiration pneumonia. Reorienting the client to the room, placing an eye patch, or performing range of motion exercises are not as critical as ensuring the client can safely swallow.

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