Nursing Elites

1. The RN at a migrant health center notes an increased incidence of dermatitis in seasonal farm workers at a local fruit farm. In response to this finding, what is the most important information for the RN to obtain as part of the community assessment?

• A. Availability of clean fresh water to wash hands after work.
• B. Proper housing
• C. Access to health care services
• D. Access to transportation

Correct answer: A

Rationale: The correct answer is A: Availability of clean fresh water to wash hands after work. Proper hand hygiene, including washing hands with clean water, is crucial in preventing dermatitis, especially in farm workers who are exposed to potential irritants in their work environment. While proper housing (choice B), access to health care services (choice C), and access to transportation (choice D) are important factors in overall community health, they are not directly linked to preventing dermatitis in this scenario.

2. The school nurse is called to the playground for an episode of mouth trauma. The nurse finds that the front tooth of a 9-year-old child has been avulsed (knocked out). After recovering the tooth, the initial response should be to

• A. Rinse the tooth in water before placing it in the socket
• B. Place the tooth in a clean plastic bag for transport to the dentist
• C. Hold the tooth by the roots until reaching the emergency room
• D. Ask the child to replace the tooth even if the bleeding continues

Correct answer: A

Rationale: The correct immediate action after recovering an avulsed tooth is to rinse it with water and place it back in the socket. This helps preserve the tooth and increases the chances of successful re-implantation. Placing the tooth in a clean plastic bag for transport to the dentist (choice B) is not ideal as immediate re-implantation is preferred. Holding the tooth by the roots until reaching the emergency room (choice C) can further damage the tooth. Asking the child to replace the tooth even if bleeding continues (choice D) is incorrect and may lead to improper re-implantation.

3. When teaching a responsible family member how to perform a certain procedure for the patient, what is the best approach?

• A. Perform all these steps
• B. Arrange for the practice of the procedure
• C. Describe the procedure
• D. Demonstrate the procedure

Correct answer: D

Rationale: The best approach when teaching a responsible family member a procedure for the patient is to demonstrate the procedure. By demonstrating, the family member can visually see how it is done, making it easier for them to understand and replicate. This hands-on approach is more effective than just describing the procedure (choice C) or arranging for practice (choice B) without a visual demonstration. Performing all the steps (choice A) may not be practical or necessary when the goal is to teach someone else how to do it.

4. Which of the following statements about breastfeeding is correct?

• A. Breastfeeding within 30 minutes after birth can stimulate breastmilk production
• B. Breastmilk should be started 24 hours after delivery
• C. Breastmilk given exclusively for the first 4 to 6 months of life helps avoid introduction of infection
• D. Breastfeeding should be done as often as the baby wants

Correct answer: C

Rationale: The correct statement about breastfeeding is that breastmilk given exclusively for the first 4 to 6 months of life helps avoid the introduction of infection. This practice is recommended by health experts for optimal infant health. Choice A is incorrect because breastfeeding should ideally start within the first hour after birth to stimulate breastmilk production. Choice B is incorrect because breastmilk should be initiated as soon as possible after delivery, not after 24 hours. Choice D is incorrect because while feeding on demand is generally encouraged, it should also follow a schedule to ensure adequate nutrition and growth for the baby.

5. With an alert of an internal disaster and the need for beds, the charge nurse is asked to list clients who are potential discharges within the next hour. Which client should the charge nurse select?

• A. An elderly client who has had type 2 diabetes for over 20 years, admitted with diabetic ketoacidosis 24 hours ago
• B. An adolescent admitted the prior night with Tylenol intoxication
• C. A middle-aged client with an internal automatic defibrillator and complaints of 'passing out at unknown times' admitted yesterday
• D. A school-age child diagnosed with suspected bacterial meningitis and was admitted at the change of shifts

Correct answer: A

Rationale: The correct answer is A because a client with diabetic ketoacidosis (DKA) that is being well-managed and has shown improvement within 24 hours is more stable and can be considered for discharge sooner than those with more acute or unstable conditions. Choice B is incorrect as Tylenol intoxication may require further monitoring and intervention. Choice C is incorrect as a client with an automatic defibrillator and episodes of passing out needs careful evaluation and monitoring. Choice D is incorrect as suspected bacterial meningitis is a serious condition that typically requires a longer hospital stay for treatment and observation.

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