Nursing Elites

1. A patient has just been admitted with probable bacterial pneumonia and sepsis. Which order should the nurse implement first?

• A. Performing a chest x-ray via stretcher
• B. Obtaining blood cultures from two sites
• C. Administering Ciprofloxacin (Cipro) 400 mg IV
• D. Inserting an Acetaminophen (Tylenol) rectal suppository

Correct answer: B

Rationale: In a patient with probable bacterial pneumonia and sepsis, the priority intervention is to obtain blood cultures from two sites before initiating antibiotic therapy. This is crucial to identify the causative organism and guide appropriate antibiotic treatment. Administering antibiotics without obtaining cultures first can interfere with accurate results. Performing a chest x-ray and administering acetaminophen can be done after obtaining blood cultures as they are important but not as urgent as identifying the causative organism in sepsis.

2. When assessing a patient being treated for Parkinson's Disease with classic symptoms, the nurse expects to note which assessment finding?

• A. Tremors
• B. Low Urine Output
• C. Exaggerated arm movements
• D. Risk for Falls

Correct answer: A

Rationale: When assessing a patient with Parkinson's Disease, the nurse should expect to note tremors as one of the cardinal signs of the condition. The classic symptoms of Parkinson's Disease include tremors, rigidity, bradykinesia (slow movements), and postural instability. Therefore, choices B, C, and D are incorrect. Low urine output is not a typical assessment finding associated with Parkinson's Disease. Exaggerated arm movements are not characteristic of the usual motor symptoms seen in Parkinson's Disease. While patients with Parkinson's Disease are at an increased risk for falls due to balance and coordination issues, 'Risk for Falls' is not an assessment finding but rather a potential nursing diagnosis based on the assessment findings.

3. A nurse is educating a patient about bimatoprost (Lumigan) eyedrops for the treatment of Glaucoma. Which of the following indicates that the patient has a correct understanding of the expected outcomes following treatment?

• A. "I should be experiencing less blurriness in my central field of vision"
• B. "This medication won't help my vision at all, but will keep it from getting worse."
• C. "My peripheral vision should be increasing back to its normal state, but will take a few weeks to do so."
• D. "This medication will help my eye restor intraocular fluid and increase intraocular pressure"

Correct answer: B

Rationale: Glaucoma cannot be cured, just treated. Treatment revolves around preventing further deterioration.

4. Which of the following measures would be appropriate for a nurse to teach the parent of a nine-month-old infant about diaper dermatitis?

• A. Use only cloth diapers that are rinsed in bleach
• B. Do not use occlusive ointments on the rash
• C. Use commercial baby wipes with each diaper change
• D. Discontinue a new food that was added to the infant's diet just prior to the rash

Correct answer: D

Rationale: Diaper dermatitis can be caused by various factors, one of which includes introducing new foods to the infant's diet. Discontinuing the new food that was added just before the rash can help identify and eliminate the potential cause. Options A and C are not directly related to addressing the cause of diaper dermatitis. While using cloth diapers rinsed in bleach may be a preventive measure for diaper dermatitis, it is not addressing a specific cause. Option B, advising against using occlusive ointments on the rash, may actually be beneficial in managing diaper dermatitis, but it does not address the cause of the condition.

5. Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which assessment data best supports this diagnosis?

• A. Weak, nonproductive cough effort
• B. Large amounts of greenish sputum
• C. Respiratory rate of 28 breaths/minute
• D. Resting pulse oximetry (SpO2) of 85%

Correct answer: A

Rationale: The correct answer is 'Weak, nonproductive cough effort.' A weak, nonproductive cough indicates that the patient is unable to clear the airway effectively, supporting the nursing diagnosis of ineffective airway clearance. In pneumonia, secretions can obstruct the airway, leading to ineffective clearance. Choices B, C, and D do not directly reflect ineffective airway clearance. Large amounts of greenish sputum (Choice B) may suggest infection or inflammation but do not specifically indicate ineffective airway clearance. The respiratory rate of 28 breaths/minute (Choice C) and a resting pulse oximetry (SpO2) of 85% (Choice D) are more indicative of impaired gas exchange or respiratory distress rather than ineffective airway clearance.

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