Nursing Elites

1. A patient in the cardiac care unit is taking bumetanide (Bumex) for heart issues and is also diagnosed with Parkinson's Disease. An unlicensed assistive personnel is assisting with feeding the patient. Which of these foods should the nurse stress for the patient to eat most?

• A. Foods containing the least amount of salt
• B. Foods containing the most amount of potassium
• C. Foods containing the most amount of calories
• D. Foods containing the most amount of fiber

Correct answer: B

Rationale: Bumex is a loop diuretic that can lead to hypokalemia (low potassium levels). Hypokalemia can be dangerous and lead to various complications. To prevent a hypokalemic crisis, it is crucial to ensure an adequate intake of potassium. Therefore, the nurse should stress the patient to eat foods rich in potassium. Choices A, C, and D are not the priority in this situation. While monitoring salt intake is important in cardiac patients, the immediate concern with bumetanide use is the risk of hypokalemia, making choice B the most appropriate option.

2. You have accompanied the physician into the family waiting room to tell a young husband that his wife has not survived the car accident she was in. The husband is crying and distraught. What is the most appropriate approach to supporting this family member?

• A. Ask if he would like to donate his wife's organs
• B. Sit quietly with him
• C. Ask about funeral arrangements
• D. Consult social services

Correct answer: B

Rationale: The most caring and supportive approach in a time of extreme distress is usually to sit quietly with the distressed individual until they have had the opportunity to absorb the news and gather themselves. Providing a supportive presence is often the most valuable tool a caregiver can use when circumstances bring overwhelming emotional pain to those they are caring for. Asking about organ donation at this moment may come off as insensitive and should not be a priority. Inquiring about funeral arrangements and consulting social services can be addressed later, once the husband has had time to process the initial shock and emotions.

3. A client in the ICU has been intubated and placed on a ventilator. The physician orders synchronous intermittent mandatory ventilation (SIMV). Which statement best describes the work of this mode of ventilation?

• A. The ventilator delivers a set rate and tidal volume regardless of whether the client is attempting to breathe
• B. The ventilator coordinates delivered breaths with the client's respiratory efforts
• C. The ventilator provides a supplemental breath for every third breath of the client
• D. The ventilator provides breaths during the expiratory phase of the client's respirations

Correct answer: B

Rationale: Synchronous intermittent mandatory ventilation (SIMV) is a ventilation mode that coordinates delivered breaths with the client's own respiratory efforts. This mode allows the client to initiate breaths, with the ventilator providing preset breaths at a controlled rate and volume. Option A is incorrect because in SIMV, the ventilator syncs with the client's respiratory efforts. Option C is incorrect as it does not accurately depict the way SIMV works. Option D is also incorrect as SIMV does not specifically provide breaths during the expiratory phase of the client's respirations. Therefore, the correct answer is B, where the ventilator coordinates breath delivery with the client's breathing efforts.

4. A 24-year-old female contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, what would serologic testing most likely reveal?

• A. antibody to hepatitis D (anti-HDV).
• B. hepatitis B surface antigen (HBsAg).
• C. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG).
• D. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM).

Correct answer: D

Rationale: Hepatitis A is primarily transmitted through the oral-fecal route. During the acute phase of hepatitis A, serologic testing typically reveals anti-hepatitis A virus immunoglobulin M (anti-HAV IgM). This antibody appears early in the course of the infection. The presence of anti-HAV IgM indicates an acute infection with hepatitis A. Choices A and B are incorrect as hepatitis D and hepatitis B antigens are not typically associated with acute hepatitis A. Choice C, anti-hepatitis A virus immunoglobulin G (anti-HAV IgG), would indicate a past infection and lifelong immunity, which is not expected during the acute phase of the illness.

5. The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which sign of this disorder documented?

• A. Watery diarrhea
• B. Ribbon-like stools
• C. Profuse projectile vomiting
• D. Bright red blood and mucus in the stools

Correct answer: D

Rationale: Intussusception is a condition where a part of the bowel slides into the next section, causing an obstruction. The classic presentation includes severe abdominal pain that is crampy, intermittent, and may cause the child to draw knees to the chest. While vomiting can occur, it is not typically projectile in nature. A key hallmark of intussusception is the passage of bright red blood and mucus in the stools, often described as currant jelly-like. Watery diarrhea and ribbon-like stools are not typical signs of intussusception and should not be expected in a child with this condition.

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