Nursing Elites

1. A healthcare worker with no known exposure to tuberculosis has received a Mantoux tuberculosis skin test. The nurse's assessment of the test after 62 hours indicates 5mm of erythema without induration. Which is the best initial nursing action?

• A. Review the healthcare worker's history for possible exposure to TB.
• B. Instruct the healthcare worker to return for a repeat test in 1 week.
• C. Refer the healthcare worker to a healthcare provider for isoniazid (INH) therapy.
• D. Document negative results in the healthcare worker's medical record.

Correct answer: D

Rationale: A Mantoux tuberculosis skin test without induration is considered negative. In this case, with 5mm of erythema and no induration, the result is negative, indicating no current infection. The best initial nursing action is to document these negative results in the healthcare worker's medical record. Reviewing the history for possible exposure to TB is unnecessary as the test result is negative. Instructing the healthcare worker to return for a repeat test or referring for INH therapy is not warranted when the test is negative.

2. A client with urolithiasis is preparing for discharge after lithotripsy. Which intervention should the nurse include in the client's postoperative discharge instructions?

• A. Report when hematuria becomes pink-tinged
• B. Use incentive spirometer
• C. Restrict physical activities
• D. Monitor urinary stream for a decrease in output

Correct answer: D

Rationale: After lithotripsy, monitoring the urinary stream for a decrease in output is essential to identify any potential complications such as urinary retention or obstruction. Reporting pink-tinged hematuria is important, but monitoring the urinary stream for a decrease in output takes precedence as it directly assesses renal function and potential complications. Using an incentive spirometer is not directly related to post-lithotripsy care. Restricting physical activities may be necessary initially but is not the priority compared to monitoring urinary output.

3. The nurse provides dietary instructions about iron-rich foods to a client with iron deficiency anemia. Which food selection made by the client indicates a need for additional instructions?

• A. Liver.
• B. Oranges.
• C. Leafy green vegetables.
• D. Kidney beans.

Correct answer: B

Rationale: The correct answer is B: Oranges. Oranges are not a rich source of iron. Iron-rich foods include liver, leafy green vegetables, and kidney beans. Oranges are a good source of vitamin C but are not high in iron. Therefore, if the client selects oranges as an iron-rich food, it indicates a need for additional instructions on choosing foods high in iron.

4. What is the most effective therapy for maintaining remission of acute lymphoblastic leukemia in a child?

• A. Surgery to remove enlarged lymph nodes
• B. Long-term chemotherapy
• C. Nutritional supplements to enhance blood cell production
• D. Blood transfusions to replace ineffective red cells

Correct answer: B

Rationale: The correct answer is B: Long-term chemotherapy. In the case of acute lymphoblastic leukemia, the most effective approach for maintaining remission is long-term chemotherapy, particularly with methotrexate, a chemotherapeutic agent. Surgery to remove enlarged lymph nodes (choice A) is not the primary treatment for leukemia. Nutritional supplements (choice C) may be beneficial for overall health but are not the mainstay of leukemia treatment. Blood transfusions (choice D) are used to manage anemia in leukemia but do not address the underlying disease process.

5. The nurse is reviewing blood pressure readings for a group of clients on a medical unit. Which client is at the highest risk for complications related to hypertension?

• A. Post-menopausal Caucasian female who overeats and is 20% above her ideal body weight.
• B. Young adult Hispanic female who has hemoglobin at 11 g/dl (110 g/L) and drinks beer daily.
• C. Older adult who consumes a diet of smoked, cured, and pickled foods.
• D. Middle-aged African-American male who has a serum creatinine level of 2.9 mg/dL (256.4 micromol/L).

Correct answer: D

Rationale: The correct answer is D. An elevated serum creatinine level indicates kidney damage, which significantly increases the risk of complications from hypertension. High blood pressure can damage the kidneys over time, leading to impaired kidney function. Choices A, B, and C do not directly correlate with increased risk of complications related to hypertension. Choice A focuses on obesity and overeating, Choice B on anemia and alcohol consumption, and Choice C on a diet high in sodium and nitrates, none of which are as directly related to hypertension complications as kidney damage.

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