Nursing Elites

1. A nursing student caring for a 6-month-old infant is asked to collect a sample for urinalysis from the infant. How should the student collect the specimen?

• A. Catheterizing the infant using the smallest available Foley catheter
• B. Attaching a urinary collection device to the infant's perineum for collection
• C. Obtaining the specimen from the diaper by squeezing the diaper after the infant voids
• D. Noting the time of the next expected voiding and then preparing a specimen cup for the urine

Correct answer: B

Rationale: The correct method for collecting a urine sample from an infant for urinalysis is by attaching a urinary collection device to the infant's perineum. This device is a plastic bag with an adhesive opening that allows it to be secured to the perineum to collect urine. Catheterizing the infant with a Foley catheter should not be done unless specifically prescribed due to the risk of infection. Obtaining the specimen from the diaper by squeezing it after the infant voids may not provide an accurate sample for urinalysis. Trying to predict the time of the next voiding to prepare a specimen cup is not practical or reliable in ensuring an appropriate sample for urinalysis.

2. An older patient is receiving standard multidrug therapy for tuberculosis (TB). The nurse should notify the health care provider if the patient exhibits which finding?

• A. Yellow-tinged skin
• B. Orange-colored sputum
• C. Thickening of the fingernails
• D. Difficulty hearing high-pitched voices

Correct answer: A

Rationale: The correct answer is 'Yellow-tinged skin.' Yellow-tinged skin is indicative of noninfectious hepatitis, a toxic effect of isoniazid (INH), rifampin, and pyrazinamide. If a patient on TB therapy develops hepatotoxicity, alternative medications will be necessary. Thickening of fingernails and difficulty hearing high-pitched voices are not typical side effects of the medications used in standard TB therapy. Presbycusis, age-related hearing loss, is common in older adults and not a cause for immediate concern. Orange-colored sputum is an expected side effect of rifampin and does not warrant immediate notification to the healthcare provider.

3. In a 24-year-old woman, the term used to define uterine bleeding in which there is no menstruation is:

• A. Oligomenorrhea
• B. Amenorrhea
• C. Menorrhagia
• D. Metrorrhagia

Correct answer: B

Rationale: Amenorrhea is the correct term for the absence of menstrual periods in a woman of childbearing age. It is typically defined as no menstruation for at least three consecutive cycles or six months. Oligomenorrhea refers to infrequent or irregular menstrual periods rather than complete absence. Menorrhagia is characterized by excessive menstrual bleeding, not the absence of menstruation. Metrorrhagia involves irregular, acyclic bleeding between menstrual periods, which is different from the absence of menstruation.

4. A patient is diagnosed with both human immunodeficiency virus (HIV) and active tuberculosis (TB) disease. Which information obtained by the nurse is most important to communicate to the healthcare provider?

• A. The Mantoux test induration measured 7 mm.
• B. The chest x-ray revealed infiltrates in the lower lobes.
• C. The patient is receiving antiretroviral therapy for HIV infection.
• D. The patient has a cough producing blood-tinged mucus.

Correct answer: C

Rationale: The most critical information to communicate to the healthcare provider in a patient diagnosed with both HIV and active TB disease is that the patient is receiving antiretroviral therapy for HIV infection. This is crucial because drug interactions can occur between antiretrovirals used to treat HIV infection and medications used to treat TB. By informing the healthcare provider about the antiretroviral therapy, potential interactions can be assessed and managed effectively to optimize patient care. The other data provided, such as the Mantoux test result, chest x-ray findings, and presence of blood-tinged mucus, are important clinical information but are expected in a patient with coexisting HIV and TB and do not directly impact potential drug interactions between antiretrovirals and TB medications.

5. Signs and symptoms of stroke may include all of the following EXCEPT:

• A. Sudden weakness or numbness of the face, arm, or leg.
• B. Sudden confusion.
• C. Sudden headache with no known cause.
• D. Hypotension.

Correct answer: D

Rationale: Hypotension is not a typical sign or symptom of an acute stroke. The correct signs and symptoms of a stroke include sudden weakness or numbness of the face, arm, or leg, sudden confusion, and a sudden headache with no known cause. Hypotension, which refers to low blood pressure, is not a common indicator of a stroke. It is important to differentiate between hypotension and hypertension in the context of stroke symptoms, as hypertension (high blood pressure) is actually a risk factor for strokes. Sudden weakness, numbness, confusion, and headache are signs associated with a stroke due to a disruption in blood flow to the brain. Hypotension, on the other hand, primarily indicates low blood pressure and is not directly linked to the typical presentation of a stroke.

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