Nursing Elites

1. Which anatomical location is associated with the deep tendon reflex known as the patellar reflex?

• A. Knee picture
• B. Ankle picture
• C. Elbow picture
• D. Wrist picture

Correct answer: A

Rationale: The patellar reflex, also called the knee-jerk reflex, is elicited by tapping the patellar tendon just below the patella. This reflex involves the quadriceps muscle and the femoral nerve. The correct answer is 'A: Knee picture' because the patellar reflex is associated with the knee joint. Choices B, C, and D are incorrect as they do not correspond to the anatomical location involved in the patellar reflex.

2. How should a healthcare professional care for a client approaching death with shortness of breath and noisy respirations?

• A. Turn the client every 2 hours
• B. Provide supplemental oxygen
• C. Use a fan to reduce the feeling of breathlessness
• D. Administer diuretics as prescribed

Correct answer: C

Rationale: In a palliative care setting, when caring for a client approaching death with symptoms of shortness of breath and noisy respirations, using a fan can help alleviate the sensation of breathlessness. This intervention can provide comfort by improving air circulation and reducing the perception of breathlessness. Turning the client every 2 hours may not directly address the respiratory distress caused by noisy respirations. Providing supplemental oxygen may not be indicated or effective in all cases, especially in end-of-life care where the focus is on comfort rather than aggressive interventions. Administering diuretics as prescribed would not be appropriate for addressing noisy respirations and shortness of breath in a dying client, as this may not be related to fluid overload or congestion. Therefore, the most appropriate action to help the client feel more comfortable in this situation is to use a fan to reduce the feeling of breathlessness.

3. The charge nurse on the unit observes that one of the staff nurses is not using proper hand washing techniques. Which is the most appropriate initial approach to correct the behavior?

• A. Remind the nurse that proper hand washing prevents infection
• B. Discuss what the nurse knows about proper hand hygiene
• C. Provide a review of the hand washing policy
• D. Refer the nurse to the infection control nurse

Correct answer: B

Rationale: The most appropriate initial approach to correct the behavior of improper hand washing by a staff nurse is to discuss what the nurse knows about proper hand hygiene. This approach helps in identifying any knowledge gaps the nurse may have and provides an opportunity to educate and correct the behavior. Option A is not the best choice as simply reminding the nurse about the importance of hand washing may not address the underlying issue of knowledge or technique. Option C, providing a review of the hand washing policy, may be necessary but is not the most immediate step to take. Option D, referring the nurse to the infection control nurse, is premature and may not be necessary if the issue can be resolved through education and communication first.

4. The nurse is assessing a client who has just been admitted with a diagnosis of acute pancreatitis. Which finding is most important for the LPN/LVN to report to the healthcare provider immediately?

• A. Elevated serum lipase level
• B. Severe abdominal pain
• C. Nausea and vomiting
• D. Hypotension

Correct answer: D

Rationale: Hypotension is a critical finding that should be reported immediately in a client with acute pancreatitis as it may indicate severe complications such as hemorrhage or shock. While elevated serum lipase level, severe abdominal pain, and nausea/vomiting are common manifestations of acute pancreatitis, hypotension is a more urgent sign requiring immediate attention to prevent further deterioration. Hypotension can be a sign of significant fluid loss, hemorrhage, or sepsis, which are potentially life-threatening conditions that need prompt intervention. Elevated serum lipase levels, severe abdominal pain, and nausea/vomiting are important in the assessment of pancreatitis but do not indicate the same level of immediate danger as hypotension does.

5. During a follow-up visit, a home health nurse notices that a client with a gastrostomy tube, who receives intermittent feedings and medications, has developed diarrhea. Which of the following findings should the nurse identify as a possible cause of the diarrhea?

• A. The client’s caregiver washes out the feeding bag once every 24 hours with warm water.
• B. The client’s caregiver washes out the feeding bag with hot water every 24 hours.
• C. The client’s caregiver changes the feeding bag every 48 hours.
• D. The client’s caregiver adds water to the formula before administration.

Correct answer: A

Rationale: The correct answer is A. Washing out the feeding bag once every 24 hours with warm water can lead to bacterial growth due to inadequate cleaning, potentially causing diarrhea. Hot water, as in choice B, can also promote bacterial growth, which is not desirable. Changing the feeding bag every 48 hours, like in choice C, is within an acceptable timeframe and is unlikely to be a cause of diarrhea. Adding water to the formula before administration, as in choice D, is a common practice to dilute the formula but is not typically associated with causing diarrhea in this scenario.

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