Nursing Elites

1. During the home visit of a client with dementia, the nurse notes that an adult daughter persistently corrects her father’s misperceptions of reality, even when the father becomes upset and anxious. Which intervention should the nurse teach the caregiver?

• A. Anxiety-reducing measures
• B. Positive reinforcement
• C. Reality orientation techniques
• D. Validation techniques

Correct answer: D

Rationale: The correct answer is D: Validation techniques. In dementia care, using validation techniques involves acknowledging the person's feelings and reality, even if it differs from actual events or facts. It helps in reducing the client's anxiety and distress. In this scenario, the daughter persistently correcting her father's misperceptions can escalate his anxiety. Teaching the daughter validation techniques will encourage her to validate her father's feelings and perceptions, ultimately promoting a more supportive and less confrontational environment. Choices A, B, and C are incorrect in this context. While anxiety-reducing measures can be beneficial, the primary issue here is the father's misperceptions being consistently corrected. Positive reinforcement focuses on rewarding desired behaviors, which is not directly related to the situation described. Reality orientation techniques involve constantly reminding the person of the correct time, place, and other details, which may not be suitable for someone with dementia experiencing distress.

2. A patient presents with a rash from poison ivy. The nurse knows that this is which type of hypersensitivity?

• A. Type I
• B. Type II
• C. Type III
• D. Type IV

Correct answer: D

Rationale: A rash from poison ivy is an example of a type IV hypersensitivity reaction. Type IV hypersensitivity reactions are delayed cell-mediated immune responses involving T cells. This type of reaction is characterized by a delayed onset, typically occurring 48-72 hours after exposure to the antigen. Choice A, Type I hypersensitivity reactions, are immediate hypersensitivity reactions mediated by IgE antibodies. Choices B and C, Type II and Type III hypersensitivity reactions, involve antibody-mediated cytotoxicity and immune complex deposition, respectively, which are not characteristic of poison ivy-induced rashes.

3. A patient has been prescribed conjugated estrogens for the treatment of menopausal symptoms. What should the nurse include in the patient teaching?

• A. Increase the intake of calcium-rich foods.
• B. Decrease the intake of high-fat foods.
• C. Avoid the use of tobacco.
• D. Avoid exposure to sunlight.

Correct answer: A

Rationale: The correct answer is A: Increase the intake of calcium-rich foods. Patients taking conjugated estrogens should increase their intake of calcium-rich foods to help prevent osteoporosis. Estrogen therapy can lead to an increased risk of osteoporosis, so ensuring an adequate intake of calcium is crucial. Choices B, decreasing high-fat foods, and C, avoiding tobacco, are general health recommendations but not directly related to the prescription of conjugated estrogens. Choice D, avoiding exposure to sunlight, is not a direct concern when taking conjugated estrogens.

4. A patient was sneezing frequently after a few days of allergic rhinitis, and she noticed her eye became red. She denies any trauma, eye pain, or visual disturbance. Physical examination reveals a subconjunctival hemorrhage. Which statement is accurate pertaining to this case?

• A. The hemorrhage will resolve without treatment within 2 weeks.
• B. The patient should be referred for immediate ophthalmologic examination.
• C. Corticosteroid eye drops will be prescribed to reduce the bleeding.
• D. Antibiotic eye drops will be prescribed to prevent infection.

Correct answer: A

Rationale: The correct answer is A: 'The hemorrhage will resolve without treatment within 2 weeks.' Subconjunctival hemorrhage typically resolves on its own without treatment. It is a self-limiting condition that does not require specific intervention. Choice B is incorrect as immediate ophthalmologic examination is not necessary for subconjunctival hemorrhage unless there are other concerning symptoms or risk factors present. Choice C is incorrect because corticosteroid eye drops are not typically used for subconjunctival hemorrhage. Choice D is also incorrect as antibiotic eye drops are not indicated since subconjunctival hemorrhage is not due to an infection.

5. Which of the following findings is commonly associated with congestive heart failure?

• A. Decreased jugular venous pressure
• B. Pulmonary edema
• C. Hyperactive bowel sounds
• D. Weight loss

Correct answer: B

Rationale: Pulmonary edema is a common finding in congestive heart failure. In congestive heart failure, the heart is unable to pump effectively, leading to fluid buildup in the lungs, causing pulmonary edema. This results in symptoms like shortness of breath, coughing, and wheezing. Choices A, C, and D are not typically associated with congestive heart failure. Jugular venous pressure is often elevated, not decreased in heart failure. Hyperactive bowel sounds and weight loss are not specific findings for congestive heart failure.

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