Nursing Elites

1. Cheryl M. has a serious swallowing disorder. She has asked you for a glass of water. The doctor has ordered honey thickness liquids for her. Water is not a honey thickness liquid. It is much thinner. What should you do?

• A. Tell the resident that she cannot have water.
• B. Give her applesauce instead of the water.
• C. Tell Cheryl that she is NPO until midnight.
• D. Thicken the water and give it to her.

Correct answer: D

Rationale: You can give Cheryl the water that she has requested; however, since water is not a honey-thick liquid as ordered by the doctor, you must thicken it with a commercial thickener before giving it to her. This will ensure that the water is at the appropriate consistency for her swallowing disorder. Choices A, B, and C are incorrect: A) Telling the resident she cannot have water is not the best course of action without attempting to modify it first. B) Giving her applesauce instead of water does not address the specific request for water. C) Placing Cheryl on NPO status until midnight is unnecessary and does not address her immediate request for water.

2. A 75-year-old man with a history of hypertension was recently changed to a new antihypertensive drug. He reports feeling dizzy at times. How would the nurse evaluate his blood pressure?

• A. Blood pressure and pulse should be recorded in the supine, sitting, and standing positions.
• B. The patient should be directed to walk around the room and his blood pressure assessed after this activity.
• C. Blood pressure and pulse are assessed at the beginning and at the end of the examination.
• D. Blood pressure is taken on the right arm and then 5 minutes later on the left arm.

Correct answer: A

Rationale: Orthostatic vital signs should be taken when the person is hypertensive or is taking antihypertensive medications, when the person reports fainting or syncope, or when volume depletion is suspected. The blood pressure and pulse readings are recorded in the supine, sitting, and standing positions.

3. Which of the following medical terms means 'surgical fixation of the stomach'?

• A. Abdominorrhaphy
• B. Gastroplasty
• C. Gastropexy
• D. Abdominorrhexis

Correct answer: C

Rationale: The correct answer is 'Gastropexy,' which means 'surgical fixation of the stomach.' This procedure involves surgically fixing the stomach in place. 'Abdominorrhaphy' refers to suturing or repairing the abdomen, not related to fixing the stomach. 'Gastroplasty' is a surgical reconstruction of the abdomen, not specifically related to fixing the stomach. 'Abdominorrhexis' refers to the rupture or tearing of the abdomen, not a surgical fixation procedure.

4. Which of the following tests would MOST LIKELY be performed on a patient who is being monitored for coagulation therapy?

• A. PT/INR
• B. CBC
• C. PTT
• D. WBC

Correct answer: A

Rationale: The correct answer is A: PT/INR. Prothrombin times (PT/INR) are commonly used to monitor patients on Coumadin (warfarin) therapy, an anticoagulant that slows the blood's ability to clot. Monitoring PT/INR levels helps ensure the patient is receiving the appropriate dosage of Coumadin. Choice B, CBC (Complete Blood Count), is a general test that provides information on red blood cells, white blood cells, and platelets but is not specific to monitoring coagulation therapy. Choice C, PTT (Partial Thromboplastin Time), is another coagulation test but is not as commonly used for monitoring Coumadin therapy. Choice D, WBC (White Blood Cell count), is unrelated to monitoring coagulation therapy and is used to assess immune system function.

5. The nurse is assessing an 8-year-old child whose growth rate measures below the third percentile for a child his age. He appears significantly younger than his stated age and is chubby with infantile facial features. Which condition does this child likely have?

• A. Acromegaly
• B. Marfan syndrome
• C. Hypopituitary dwarfism
• D. Achondroplastic dwarfism

Correct answer: C

Rationale: Hypopituitary dwarfism is caused by a deficiency in growth hormone in childhood and results in a retardation of growth below the third percentile, delayed puberty, and other problems. The child's appearance fits this description. Achondroplastic dwarfism is a genetic disorder resulting in characteristic deformities; Marfan syndrome is an inherited connective tissue disorder characterized by a tall, thin stature and other features. Acromegaly is the result of excessive secretion of growth hormone in adulthood which causes overgrowth of bone in the face, head, hands, and feet.

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