Nursing Elites

1. A child diagnosed with Hepatitis A is under the care of a healthcare provider. Which of the following precautions would be most important to take to prevent the transmission of this infectious disease?

• A. Encourage the Hepatitis A vaccine for family members and siblings
• B. Use needleless systems if possible; otherwise, use careful needle precautionary measures
• C. Teach the child and enforce strict and frequent hand washing
• D. Teach the child and family about the dangers of contaminated food and water

Correct answer: C

Rationale: The most crucial precaution to prevent the transmission of Hepatitis A is to emphasize strict and frequent hand washing. Hepatitis A is a virus that spreads through the oral-fecal route and can survive on human hands. Hand washing is the most effective measure to reduce the risk of transmission. Encouraging the Hepatitis A vaccine for family members and siblings (Choice A) is beneficial for prevention but not as directly impactful as hand washing. While needle precautions (Choice B) are important in healthcare settings, they are not directly relevant to preventing the spread of Hepatitis A. Teaching about the dangers of contaminated food and water (Choice D) is important for general hygiene but may not be as effective as emphasizing hand hygiene in preventing the spread of Hepatitis A.

2. The mother of a child with hepatitis A tells the home care nurse that she is concerned because the child's jaundice seems worse. What is the nurse's best response?

• A. You need to change the child's diet.
• B. The child probably is infectious again.
• C. The jaundice may worsen before it resolves.
• D. You need to call the primary health care provider.

Correct answer: C

Rationale: The best response for the nurse in this situation is to explain to the mother that jaundice may seem to worsen before it eventually gets better. This is a common occurrence in hepatitis A. Option A about changing the child's diet is irrelevant to the concern raised by the mother and not supported by evidence. Option B suggesting the child is infectious again is incorrect and may cause unnecessary alarm as jaundice does not indicate reinfection. Option D, advising the mother to call the primary health care provider, is premature as the nurse can first provide education and reassurance regarding the expected course of jaundice in hepatitis A.

3. Which of the following is TRUE about shock?

• A. A patient with severe shock does not always have an abnormally low blood pressure.
• B. Confusion and deteriorating mentation are indicative of hypotensive shock.
• C. Patients with compensated shock may not be able to maintain a normal blood pressure.
• D. A normal blood pressure does not imply that the patient is stable.

Correct answer: B

Rationale: Confusion and deteriorating mentation are indeed indicative of hypotensive shock. It is important to note that a patient with hypotensive shock will likely exhibit deteriorating mental status. Choice A is incorrect because a patient in severe shock may not always have an abnormally low blood pressure, making it an unreliable indicator of shock severity. Choice C is incorrect because patients with compensated shock may present with normal blood pressure but still have inadequate tissue perfusion. Choice D is incorrect because a normal blood pressure does not guarantee the patient's stability, especially in cases of shock where tissue perfusion may be compromised despite normal blood pressure readings.

4. While auscultating a patient's lungs, the nurse hears low-pitched, bubbling sounds during inhalation in the lower third of both lungs. How should the nurse document this finding?

• A. Inspiratory crackles at the bases
• B. Expiratory wheezes in both lungs
• C. Abnormal lung sounds in the apices of both lungs
• D. Pleural friction rub in the right and left lower lobes

Correct answer: A

Rationale: The correct answer is 'Inspiratory crackles at the bases.' Crackles are low-pitched, bubbling sounds typically heard during inspiration, which aligns with the nurse's finding. Expiratory wheezes are high-pitched sounds and are not consistent with the described auscultation findings. The lower third of both lungs refers to the bases, not the apices, so option C is incorrect. Pleural friction rubs are grating sounds heard during both inspiration and expiration, unlike the described finding of only hearing the sounds during inhalation in the lower third of both lungs.

5. A nurse is caring for a patient with peripheral vascular disease (PVD). The patient complains of burning and tingling of the hands and feet and cannot tolerate touch of any kind. Which of the following is the most likely explanation for these symptoms?

• A. Inadequate tissue perfusion leading to nerve damage.
• B. Fluid overload leading to compression of nerve tissue.
• C. Sensation distortion due to psychiatric disturbance.
• D. Inflammation of the skin on the hands and feet.

Correct answer: A

Rationale: Patients with the peripheral vascular disease often sustain nerve damage as a result of inadequate tissue perfusion. Ischemic rest pain is more worrisome; it refers to pain in the extremity that is due to a combination of PVD and inadequate perfusion. Ischemic rest pain often is exacerbated by poor cardiac output. The condition is often partially or fully relieved by placing the extremity in a dependent position, so that perfusion is enhanced by the effects of gravity.

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