Nursing Elites

1. A nursing student is teaching a patient and family about epilepsy prior to the patient's discharge. For which statement should you intervene?

• A. "You should avoid consumption of all forms of alcohol."?
• B. "Wear your medical alert bracelet at all times."?
• C. "Protect your loved one's airway during a seizure."?
• D. "It's important to consult with your physician before taking over-the-counter medications."?

Correct answer: D

Rationale: The correct answer is, "It's important to consult with your physician before taking over-the-counter medications."? Patients with epilepsy should not take over-the-counter medications without medical advice due to potential interactions with antiepileptic drugs or triggering seizures. Choices A, B, and C are all appropriate statements for a patient with epilepsy, focusing on alcohol avoidance, wearing a medical alert bracelet, and airway protection during a seizure, respectively. Choice D is incorrect because patients with epilepsy need to be cautious about medications due to possible interactions or adverse effects, so consulting with a physician is crucial before taking over-the-counter medications.

2. The chain of infection includes the ________________.

• A. germ, agent, reservoir, exit portal, mode of transmission, entry port, and susceptible host
• B. active natural, active artificial, passive natural, and passive artificial
• C. opportunism, weakness, immunity, and colonization
• D. intrinsic, extrinsic, internal, and external transmission

Correct answer: A

Rationale: The chain, or cycle, of infection includes the germ (microorganism), agent, reservoir, exit portal, mode of transmission, entry port, and susceptible host. This sequence describes how infections are passed from one person to another. Choice B is incorrect because it refers to types of immunity, not components of the chain of infection. Choice C is also incorrect as it lists terms unrelated to the chain of infection. Choice D is incorrect as it describes transmission types, not components of the chain of infection. Understanding the chain of infection is crucial in preventing the spread of infections by breaking one or more links in the chain, such as interrupting the mode of transmission through proper hand hygiene.

3. You are caring for a group of elderly clients, many of whom are affected by multiple chronic disorders and are also, at times, affected by some acute disorders that require medical and nursing attention. As you are caring for these clients, some will need a new medication regimen for an acute disorder. You should consider the fact that the elderly population is at risk for more side effects, adverse drug reactions, and toxicity due to the elderly having a(n):

• A. Increased creatinine clearance.
• B. Impaired immune system.
• C. Decreased hepatic metabolism.
• D. Increased bodily fat

Correct answer: C

Rationale: The correct answer is 'Decreased hepatic metabolism.' The elderly population is at risk for more side effects, adverse drug reactions, and toxicity due to a decrease in hepatic metabolism. This is caused by changes in hepatic functioning in the elderly, including decreased hepatic blood flow and functioning. Choice A, 'Increased creatinine clearance,' is incorrect as aging typically results in decreased, not increased, creatinine clearance. Choice B, 'Impaired immune system,' is not directly related to the increased risk of adverse drug reactions in the elderly. Choice D, 'Increased bodily fat,' is not a primary factor contributing to the increased risk of medication-related issues in the elderly population.

4. A client with hyperkalemia may exhibit peaked T waves on an electrocardiogram. This manifestation is an early sign of high potassium levels, but the diagnosis should not be based on this aspect alone. Untreated, hyperkalemia can lead to progressively worsening cardiac instability.

• A. A lumbar puncture takes a sample of cerebrospinal fluid from the back, which will be analyzed by the lab.
• B. The physician will insert a needle at the level of L4-L5 in the spinal cord.
• C. The client should lie flat on their back for a specific period following the procedure.
• D. The risks of the procedure include headache, back pain, and infection.

Correct answer: B

Rationale: A lumbar puncture is performed to obtain cerebrospinal fluid for analysis to investigate various conditions affecting the client. During the procedure, the client is typically positioned on their side or sitting leaning over a table with their back rounded. The physician inserts a needle into the back around the L4-L5 vertebrae to collect the sample. Option A is incorrect because a lumbar puncture does not draw blood but instead collects cerebrospinal fluid. Option C is incorrect as the client should not necessarily lie flat for 24 hours post-procedure. Option D is incorrect as the common risks of a lumbar puncture include headache, back pain, and potential infection, not nausea, rash, or hypotension.

5. Elderly patients are more prone to dehydration than younger people because the elderly ___________.

• A. drink more coffee and tea
• B. have more stomach mucus production
• C. have more saliva
• D. have less sense of thirst

Correct answer: D

Rationale: Elderly patients are prone to dehydration because they have a lower and diminished sense of thirst. This reduced sensation of thirst makes them less likely to drink an adequate amount of fluids, leading to dehydration. While it is true that elderly individuals may also have changes such as decreased stomach mucus production and saliva production, these factors do not directly contribute to dehydration. Drinking more coffee and tea, as mentioned in choice A, is not a consistent behavior among all elderly individuals and is not a primary reason for their increased risk of dehydration.

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