Nursing Elites

1. A patient is deciding whether they should take the live influenza vaccine (nasal spray) or the inactivated influenza vaccine (shot). The nurse reviews the client's history. Which condition would NOT contraindicate the nasal (live vaccine) route of administration?

• A. The patient takes long-term corticosteroids
• B. The patient is not feeling well today
• C. The patient is 55 years old
• D. The patient has young children

Correct answer: D

Rationale: The correct answer is that the patient has young children. Having young children is not a contraindication for the live influenza vaccine unless the children are immunocompromised, which is not mentioned. Choice A, the patient taking long-term corticosteroids, is a contraindication for the live vaccine due to potential immunosuppression. Choice B, the patient not feeling well today, is a general precaution for vaccination and not a contraindication specific to the live influenza vaccine. Choice C, the patient being 55 years old, is not a contraindication for the live vaccine unless there are other specific medical conditions present.

2. The nurse is caring for clients in the pediatric unit. A 6-year-old patient is admitted with 2nd and 3rd degree burns on his arms. The nurse should assign the new patient to which of the following roommates?

• A. A 4-year-old with sickle-cell disease
• B. A 12-year-old with chickenpox
• C. A 6-year-old undergoing chemotherapy
• D. A 7-year-old with a high temperature

Correct answer: A

Rationale: The nurse should be concerned about the burn patient's vulnerability to infection due to compromised skin integrity. Sickle cell disease is not a communicable disease, so rooming the burn patient with a 4-year-old with sickle-cell disease would not pose an increased risk of infection transmission. Rooming the burn patient with a 12-year-old with chickenpox would increase the risk of infection for the burn patient. Rooming with a 6-year-old undergoing chemotherapy may expose the burn patient to potential infections. A 7-year-old with a high temperature could potentially have a contagious illness, which could be risky for the burn patient.

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. The nurse reviews the record of a child who is suspected to have glomerulonephritis. Which statement by the child's parent should the nurse expect that is associated with this diagnosis?

• A. ''His pediatrician said his kidneys are working well.''
• B. ''I noticed his urine was the color of cola lately.''
• C. ''I'm so glad they didn't find any protein in his urine.''
• D. ''The nurse who admitted my child said his blood pressure was low.''

Correct answer: B

Rationale: Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. Gross hematuria, resulting in dark, smoky, cola-colored, or brown-colored urine, is a classic symptom of glomerulonephritis. Blood urea nitrogen levels and serum creatinine levels may be elevated, indicating that kidney function is compromised. A mild to moderate elevation in protein in the urine is associated with glomerulonephritis. Hypertension is also common because of fluid volume overload secondary to the kidneys not working properly. Therefore, the parent's statement about noticing cola-colored urine aligns with the expected symptom in glomerulonephritis. The other options are less indicative of glomerulonephritis: choice A indicates normal kidney function, choice C mentions absence of protein in the urine (which is not expected in glomerulonephritis), and choice D talks about low blood pressure (hypertension is more common in glomerulonephritis).

5. A patient who has a history of chronic obstructive pulmonary disease (COPD) was hospitalized for increasing shortness of breath and chronic hypoxemia (SaO2 levels of 89% to 90%). In planning for discharge, which action by the nurse will be most effective in improving compliance with discharge teaching?

• A. Start giving the patient discharge teaching on the day of discharge
• B. Have the patient repeat the instructions immediately after teaching
• C. Accomplish the patient teaching just before the scheduled discharge
• D. Arrange for the patient's caregiver to be present during the teaching

Correct answer: D

Rationale: Hypoxemia interferes with the patient's ability to learn and retain information, so having the patient's caregiver present will increase the likelihood that discharge instructions will be followed. Having the patient repeat the instructions will indicate that the information is understood at the time, but it does not guarantee retention of the information. Giving discharge instructions just before discharge is not ideal as the patient is likely to be distracted and anxious at that time. Teaching the patient about discharge on the day of admission is not recommended because the patient may be more hypoxemic and anxious than usual, making it difficult for them to absorb and retain the information effectively. Therefore, arranging for the patient's caregiver to be present during the teaching session is the best option to ensure proper compliance and understanding of the discharge instructions.

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