Nursing Elites

1. A female client makes routine visits to a neighborhood community health center. The nurse notes that this client often presents with facial bruising, particularly around the eyes. The nurse discusses prevention of domestic violence with the client even though the client does not admit to being battered. What level of prevention has the nurse applied in this situation?

• A. primary prevention
• B. secondary prevention
• C. tertiary prevention
• D. health promotion

Correct answer: B

Rationale: The correct answer is B: secondary prevention. Secondary prevention involves identifying and addressing issues early to prevent further harm. In this scenario, the nurse is intervening by discussing domestic violence prevention with the client who is showing signs of facial bruising, aiming to prevent further harm even though the client has not disclosed being battered. Choice A (primary prevention) focuses on preventing the onset of a problem before it occurs, like educating about healthy relationships before violence happens. Choice C (tertiary prevention) involves managing and treating the effects of a problem that has already occurred, such as providing counseling to a domestic violence survivor. Choice D (health promotion) aims to enhance well-being and prevent health problems through educational and environmental interventions, which may include aspects of preventing domestic violence, but in this case, the nurse's direct intervention is more about early identification and prevention of harm, aligning it with secondary prevention.

2. A client presents at a community-based clinic with complaints of shortness of breath, headache, dizziness, and nausea. During the assessment, the nurse learns that the client is a migrant worker who often uses a gasoline-powered pressure washer to clean equipment and farm buildings. Which type of poisoning is the most likely etiology of this client's symptoms?

• A. asbestos
• B. silica dust
• C. histoplasmosis
• D. carbon monoxide

Correct answer: D

Rationale: The client's symptoms of shortness of breath, headache, dizziness, and nausea are indicative of carbon monoxide poisoning, which can result from exposure to gasoline-powered equipment like pressure washers. Asbestos (Choice A) exposure would typically present with respiratory issues and cancer but not the rapid onset of symptoms described. Silica dust (Choice B) exposure is associated with respiratory conditions like silicosis, not the multisystem symptoms in the scenario. Histoplasmosis (Choice C) is a fungal infection that primarily affects the lungs and is not related to the client's exposure to a gasoline-powered pressure washer.

3. The following are functions of the Provincial Nurse Supervisor except:

• A. interpreting policies, guidelines, and SDP to nursing and midwifery staff of the province
• B. assessing training needs and planning staff development programs for nursing and midwifery staff
• C. participating in planning, developing, and evaluating OJT for nurses and midwives conducted by the department
• D. collecting, consolidating, analyzing, and interpreting health records and reports and making recommendations as needed

Correct answer: D

Rationale: The correct answer is D. Collecting, consolidating, analyzing, and interpreting health records is not a primary function of a Provincial Nurse Supervisor. The primary functions of a Provincial Nurse Supervisor include interpreting policies, guidelines, and SDP to nursing and midwifery staff, assessing training needs, planning staff development programs, and participating in planning, developing, and evaluating OJT for nurses and midwives. While health records may be accessed for specific purposes, the core responsibilities of a Provincial Nurse Supervisor focus on staff management and development rather than direct involvement in health record analysis.

4. A client with tuberculosis is receiving isoniazid (INH). The nurse should monitor the client for which of the following side effects?

• A. Hepatotoxicity
• B. Hyperglycemia
• C. Hypotension
• D. Hypokalemia

Correct answer: A

Rationale: The correct answer is A: Hepatotoxicity. Isoniazid (INH) can lead to hepatotoxicity, necessitating the monitoring of liver function tests. This adverse effect is characterized by liver damage and dysfunction. Choices B, C, and D are incorrect because isoniazid is not typically associated with hyperglycemia, hypotension, or hypokalemia. Therefore, the nurse should focus on assessing for signs and symptoms of hepatotoxicity in a client receiving isoniazid.

5. The community health nurse has been following the care for an adolescent with a history of morbid obesity, asthma, hypertension, and is 22 weeks into a pregnancy. Which of these lab reports sent to the clinic needs to be called to the teen's healthcare provider within the next hour?

• A. Hemoglobin 11 g/dL and calcium 6 mg/dL
• B. Magnesium 0.8 mEq/L and creatinine 3 mg/dL
• C. Blood urea nitrogen 28 mg/dL and glucose 225 mg/dL
• D. Hematocrit 33% and platelets 200,000

Correct answer: B

Rationale: The correct answer is B. The low magnesium level and elevated creatinine suggest possible renal dysfunction, which is concerning, especially in a pregnant client with multiple risk factors such as morbid obesity, asthma, and hypertension. Immediate attention is needed to address the potential renal issues. The other choices do not indicate such urgent conditions. Hemoglobin and calcium levels in choice A are within acceptable ranges. Choice C shows elevated blood urea nitrogen and glucose levels, which may need monitoring but not immediate attention. Choice D's hematocrit and platelet levels are also within normal ranges and do not indicate an urgent issue.

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