Nursing Elites

1. A healthcare provider is screening patients for various vaccines. Which of the following vaccines is contraindicated during pregnancy?

• A. Diphtheria
• B. Hepatitis B
• C. Mumps
• D. Tetanus

Correct answer: C

Rationale: The correct answer is Mumps. The Mumps vaccine, along with the Rubella vaccine, is contraindicated during pregnancy due to the theoretical risk of affecting the developing fetus. Diphtheria, Hepatitis B, and Tetanus vaccines are considered safe during pregnancy and are often recommended to protect both the pregnant individual and the developing fetus. Therefore, choices A, B, and D are incorrect.

2. Which client should be seen first by the Emergency Department nurse?

• A. A six-year-old with a femur fracture.
• B. A two-year-old with a fever of 102 degrees F.
• C. A three-year-old with wheezes in the right lower lobe.
• D. A two-year-old whose gastrostomy tube came out.

Correct answer: C

Rationale: The priority in the emergency department is to assess and manage clients based on the severity of their condition. In this scenario, the three-year-old with wheezes in the right lower lobe should be seen first because respiratory distress takes precedence over other conditions. Wheezing indicates potential airway compromise, which requires immediate attention to ensure adequate oxygenation. The other options are important but do not pose an immediate threat to the client's airway and breathing. A femur fracture, fever, or a dislodged gastrostomy tube can be addressed after ensuring the child with respiratory distress is stable.

3. Which reported symptom would indicate a client with Addison's disease has received too much fludrocortisone (Florinef) replacement?

• A. Oily skin and hair
• B. Weight gain of 6 pounds in one week
• C. Loss of muscle mass in arms and legs
• D. Increased blood glucose level

Correct answer: B

Rationale: Fludrocortisone (Florinef) replacement in Addison's disease involves mimicking aldosterone to retain sodium and water. This retention can lead to weight gain due to increased fluid retention. Rapid weight gain, such as 6 pounds in one week, is a concerning sign of excessive fluid retention, indicating a potential overdose of fludrocortisone. Choices A, C, and D are incorrect because oily skin and hair, loss of muscle mass, and increased blood glucose levels are not specific symptoms of excessive fludrocortisone replacement in Addison's disease.

4. A nurse is assigned to do pre-operative teaching on a blind patient who is scheduled for surgery the following morning. What teaching strategy would best fit the situation?

• A. Verbal teaching in short sessions throughout the day
• B. Provide a pre-operative booklet in Braille
• C. Provide an audio recording for the client
• D. Have the blind patient's family member assist with the instruction

Correct answer: A

Rationale: For a blind patient scheduled for surgery the following morning, the best teaching strategy would be verbal teaching in short sessions throughout the day. Providing information in smaller amounts makes it easier to retain, and one-on-one teaching is most effective. Choice B, providing a pre-operative booklet in Braille, may not be as practical for last-minute teaching. Choice C, providing an audio recording, may not allow for immediate interaction and clarification. Choice D, having a family member instruct the patient, may not ensure the accuracy and clarity of the information provided.

5. A woman is in the active phase of labor. An external monitor has been applied, and a fetal heart deceleration of uniform shape is observed, beginning just as the contraction is underway and returning to the baseline at the end of the contraction. Which of the following nursing actions is most appropriate?

• A. Administer O2.
• B. Turn the client on her left side.
• C. Notify the physician.
• D. No action is necessary

Correct answer: D

Rationale: This scenario describes early deceleration due to head compression, which is a benign finding in labor. Early decelerations mirror the contractions and do not require any intervention as they are considered a normal response to fetal head compression. The fetal heart rate returns to baseline at the end of the contraction. In this case, the correct action is no action at the moment. Close monitoring of the mother and baby is essential, but immediate intervention is not required. Administering O2 (Choice A) or turning the client on her left side (Choice B) is not indicated for early decelerations. Notifying the physician (Choice C) is unnecessary for this type of deceleration.

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