Nursing Elites

1. After delivery, a newborn undergoes an Apgar assessment. What does this scoring system evaluate?

• A. heart rate, respiratory effort, color, muscle tone, reflex irritability
• B. heart rate, bleeding, cyanosis, edema
• C. bleeding, reflex, edema
• D. respiratory effort, heart rate, seizures

Correct answer: B

Rationale: The Apgar scoring system, developed by Virginia Apgar, an anesthesiologist, evaluates newborns based on five criteria: heart rate, respiratory effort, color, muscle tone, and reflex irritability. These parameters provide a quick and simple assessment of a newborn's overall condition and the need for immediate medical attention. Choices B, C, and D are incorrect as they do not encompass the essential elements evaluated by the Apgar scoring system.

2. The healthcare professional seeks to assess the renal function of an elderly client who is about to receive a nephrotoxic medication. Which of the following labs provides the best indicator for renal function?

• A. urinalysis
• B. creatinine and blood urea nitrogen
• C. chemistry of electrolytes
• D. creatinine clearance

Correct answer: D

Rationale: In the context of an elderly client, assessing renal function before administering a nephrotoxic medication is crucial. While urinalysis and blood urea nitrogen provide valuable information on hydration status and overall health clues, they are not specific indicators of renal function. The chemistry of electrolytes may show abnormalities in renal failure, but it does not directly measure the kidneys' ability to eliminate waste. Creatinine clearance, on the other hand, is considered the best indicator for renal function in the elderly. This test accounts for decreases in lean body mass that can affect blood creatinine levels and is widely used to estimate the glomerular filtration rate, reflecting the kidneys' filtration capability. Therefore, creatinine clearance is the most appropriate lab test to assess renal function in this scenario.

3. Several passengers aboard an airliner suddenly become weak and suffer breathing difficulty. The diagnosis is likely to be

• A. Outbreak of Asian flu.
• B. Chemical exposure.
• C. Bacterial pneumonia.
• D. Allergic reaction.

Correct answer: B

Rationale: In the scenario described, where multiple passengers on an airliner experience sudden weakness and breathing difficulty simultaneously, the most likely cause is chemical exposure. This is because a sudden onset of similar symptoms in a group of individuals suggests a common environmental factor affecting them. Options A, C, and D are less likely as they do not explain a sudden onset of symptoms in multiple individuals simultaneously. Asian flu (Option A) is a viral infection and would not typically result in sudden symptoms in multiple individuals at the same time. Bacterial pneumonia (Option C) is a localized infection and not a probable cause for a sudden onset of symptoms in a group. An allergic reaction (Option D) would usually occur in individuals with specific allergies rather than affecting a group of passengers at the same time.

4. A child comes to the clinic with a skin rash. The maculopapular lesions are distributed around the mouth and have honey-colored drainage. The caregiver states that the rash is getting worse and seems to spread with the child's scratching. Which of the following advisory comments should be given?

• A. The history and presentation might indicate chickenpox, a highly contagious disease.
• B. The lesions might indicate a noncontagious infection that does not require isolation.
• C. The history and presentation might indicate an infectious illness called impetigo.
• D. The lesions are not contagious unless others have open wounds or lesions themselves.

Correct answer: C

Rationale: The scenario describes classic impetigo, characterized by maculopapular lesions with honey-colored drainage, typically caused by Staphylococcus aureus or Streptococcus pyogenes. Antibiotic therapy is usually indicated for impetigo. Chickenpox, a highly contagious disease, presents with a history of high fever followed by a vesicular rash, different from the described maculopapular lesions with honey-colored drainage. Choice A is incorrect as the presentation is not consistent with chickenpox. Choice B is incorrect because impetigo is contagious, especially through direct contact. Choice D is also incorrect as impetigo is a contagious skin infection regardless of others having open wounds or lesions.

5. While preparing a client for a bronchoscopy, a nurse notes that the client is wearing a gold necklace. What should the nurse do to safeguard the client's necklace?

• A. Ask the client for permission to lock the necklace in the hospital safe
• B. Ask the client to remove the necklace and place it in the top drawer of the bedside table
• C. Ask the client whether the necklace is gold
• D. Ask the client to sign a release to free the hospital of responsibility if the necklace is damaged or lost during the procedure

Correct answer: A

Rationale: When a client has valuables such as jewelry, the nurse should ensure their safekeeping. It is appropriate for the nurse to ask the client for permission to lock the necklace in the hospital safe to prevent loss or damage. This option prioritizes the security of the necklace while allowing the client to make an informed decision. Asking the client to sign a release form does not guarantee the necklace's safety; it only releases the hospital from liability. Placing the necklace in a bedside table drawer does not provide adequate security as it is not as secure as a hospital safe. Inquiring whether the necklace is gold is irrelevant to safeguarding the jewelry during the procedure, as the primary concern is its safekeeping.

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