Nursing Elites

1. In a long term rehabilitation care unit a client with spinal cord injury complains of a pounding headache. The client is sitting in a wheelchair watching television in the assigned room. Further assessment by the nurse reveals excessive sweating, a splotchy rash, pilomotor erection, facial flushing, congested nasal passages and a heart rate of 50. The nurse should do which action next?

• A. Take the client's respirations, blood pressure (BP), temperature and then pupillary responses
• B. Place the client into the bed and administer the ordered PRN analgesic
• C. Check the client for bladder distention and the client's urinary catheter for kinks
• D. Turn the television off and then assist client to use relaxation techniques

Correct answer: C

Rationale: These symptoms suggest autonomic dysreflexia, often triggered by bladder distention.

2. During an initial clinic visit, the nurse is taking the history for a client who wants to confirm her pregnancy. The client's last child has a history of low-birth-weight (LBW). Which additional finding is most important for the nurse to consider?

• A. Cigarette smoking.
• B. African American ethnicity.
• C. Poor nutritional status.
• D. Limited maternal education.

Correct answer: A

Rationale: The correct answer is A: Cigarette smoking. Cigarette smoking is a significant risk factor for low birth weight. Smoking during pregnancy reduces the amount of oxygen available to the baby, leading to LBW. Choice B, African American ethnicity, while it may be a risk factor, is not as directly linked to LBW as cigarette smoking. Choice C, poor nutritional status, can contribute to LBW but is not as significant as cigarette smoking in this case. Choice D, limited maternal education, is an important social determinant of health but is not as directly related to LBW as cigarette smoking.

3. A home health nurse is at the home of a client with diabetes and arthritis. The client has difficulty drawing up insulin. It would be most appropriate for the nurse to refer the client to:

• A. A social worker from the local hospital
• B. An occupational therapist from the community center
• C. A physical therapist from the rehabilitation agency
• D. Another client with diabetes mellitus who takes insulin

Correct answer: B

Rationale: An occupational therapist is the most appropriate professional to refer the client to in this situation. Occupational therapists can provide assistance with techniques and tools to help the client manage insulin administration despite arthritis. Referring the client to a social worker (Choice A) may not directly address the client's difficulty with insulin. While physical therapists (Choice C) focus on mobility and strength, they may not specialize in techniques for insulin administration. Referring the client to another client with diabetes (Choice D) is not a professional or appropriate solution to address the client's difficulty.

4. Which of the following statements about TB treatment is INCORRECT?

• A. Combination of 3-4 anti-TB drugs is the treatment of choice
• B. Single drug therapy is appropriate
• C. Treatment renders patients non-infectious and cured
• D. Tuberculosis is a curable disease

Correct answer: B

Rationale: The correct answer is B. Single drug therapy is not appropriate for TB due to the risk of developing resistance. The most effective approach to TB treatment is a combination of 3-4 anti-TB drugs. This combination helps to prevent the development of drug resistance and improve treatment outcomes. Choice C is correct as TB treatment, when completed successfully, renders patients non-infectious and cured. Choice D is also correct as tuberculosis is indeed a curable disease with appropriate treatment. Therefore, the incorrect statement is B.

5. Which of the following measures the proportion of the population that exhibits a particular disease at a particular time and includes both new and old cases?

• A. proportionate morbidity rate
• B. case fatality rate
• C. incidence ratio
• D. prevalence ratio

Correct answer: D

Rationale: The correct answer is D, prevalence ratio. Prevalence ratio measures the proportion of the population with a particular disease at a specific time, including both new and existing cases. Choice A, proportionate morbidity rate, is not a standard term and might confuse students. Choice B, case fatality rate, measures the proportion of deaths from a specific disease compared to the total number of cases but does not include both new and old cases. Choice C, incidence ratio, measures the rate of new cases of a disease in a specific population over a defined period, not considering existing cases.

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