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 client is seven (7) days post total hip replacement. Which statement by the client requires the nurse's immediate attention?

• A. I have bad muscle spasms in my lower leg of the affected extremity.
• B. I just can't 'catch my breath' over the past few minutes and I think I am in grave danger.
• C. I have to use the bedpan to pass my water at least every 1 to 2 hours.
• D. It seems that the pain medication is not working as well today.

Correct answer: B

Rationale: While all statements by the client require attention, the most critical one that demands immediate action is option B. Clients who have undergone hip or knee surgery are at an increased risk of postoperative pulmonary embolism. Sudden dyspnea and tachycardia are hallmark signs of this condition. Without appropriate prophylaxis such as anticoagulant therapy, deep vein thrombosis (DVT) can develop within 7 to 14 days after surgery, potentially leading to pulmonary embolism. It is crucial for the nurse to recognize signs of DVT, which include pain, tenderness, skin discoloration, swelling, or tightness in the affected leg. Signs of pulmonary embolism include sudden onset dyspnea, tachycardia, confusion, and pleuritic chest pain. Option B indicates a potentially life-threatening situation that requires immediate intervention to prevent serious complications.

3. What is the likely cause of pericarditis in a young patient?

• A. Heart failure
• B. Acute MI
• C. Hypertension
• D. Infectious processes

Correct answer: D

Rationale: In younger patients, pericarditis is typically caused by an infection commonly triggered by viruses like the Coxsackie virus, streptococcus, staphylococcus, or Haemophilus influenzae. Infectious processes are the leading cause of pericarditis in younger individuals. Heart failure, Acute MI, and Hypertension are not common causes of pericarditis in young patients. In older adults, acute myocardial infarction (MI) is a more common cause of pericarditis.

4. A man has been taking lisinopril for CHF. The patient is seen in the emergency room for persistent diarrhea. The nurse is concerned about which side effect of lisinopril?

• A. Vertigo
• B. Hypotension
• C. Palpitations
• D. Nagging, dry cough

Correct answer: B

Rationale: The correct answer is 'Hypotension.' Lisinopril, an ACE inhibitor commonly used for CHF, can cause hypotension as a side effect. Persistent diarrhea can lead to dehydration, increasing the risk of hypotension in this patient. Vertigo (choice A) is not a typical side effect of lisinopril. Palpitations (choice C) are not directly associated with lisinopril use. A nagging, dry cough (choice D) is a common side effect of ACE inhibitors like lisinopril, but in this case, the patient's presentation with persistent diarrhea would make hypotension a more immediate concern.

5. What intervention should the nurse implement while a client is having a grand mal seizure?

• A. Open the jaw and place a bite block between the teeth
• B. Try to place the client on his side
• C. Restrain the client to prevent injury
• D. Place pillows around the client

Correct answer: B

Rationale: During a grand mal seizure, the client is at risk of injury due to severe, involuntary muscle spasms and contractions. It is crucial for the nurse to avoid restraining the client or inserting objects into their mouth, as these actions may lead to further harm. Placing the client on their side can help facilitate the drainage of oral secretions and assist in maintaining an open airway, reducing the risk of aspiration. Restraint should be avoided as it can exacerbate muscle contractions and increase the risk of injury. Placing pillows around the client may not provide adequate support or protection during the seizure, making it a less effective intervention compared to positioning the client on their side.

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