Nursing Elites

1. Madge is a 91-year-old nursing home resident with a history of dementia and atrial fibrillation who has been admitted to the hospital for treatment of pneumonia. As you are performing her bed bath, you note bruising around her breasts and genital area. What potential issue should be of major concern in Madge's situation?

• A. Idiopathic thrombocytopenic purpura (ITP)
• B. Embolic stroke
• C. Sexual abuse
• D. Nursing home-acquired pneumonia (NHAP)

Correct answer: C

Rationale: Bruising around the breasts and genitals should trigger concern for sexual abuse. Elder abuse is a growing problem in America, and nurses are uniquely positioned to recognize and intervene on behalf of vulnerable populations, such as the elderly. According to the National Center on Elder Abuse (NCEA), major types of elder abuse include physical abuse, sexual abuse, emotional or psychological abuse, neglect, abandonment, financial or material exploitation, and self-neglect. In this scenario, given Madge's age, history of dementia, and the presence of unexplained bruising in sensitive areas, sexual abuse must be considered as a major concern. Idiopathic thrombocytopenic purpura (ITP) is a platelet disorder that presents with excessive bruising and bleeding, but it is less likely in this case as the bruising pattern is suggestive of a different cause. Embolic stroke is a neurological condition that typically presents with sudden onset neurological deficits and is not related to the observed bruising. Nursing home-acquired pneumonia (NHAP) is a common issue in elderly residents but would not manifest as bruising in specific areas like the breasts and genitals.

2. Who should be members of a patient care conference?

• A. Doctors, nurses, and nursing assistants since they are healthcare providers
• B. Doctors, nurses, and the patient and/or the family members
• C. ALL members of the healthcare team
• D. ALL members of the healthcare team and the patient/resident

Correct answer: D

Rationale: In a patient care conference, it is essential to have all members of the healthcare team present to ensure comprehensive and coordinated care. Including the patient or resident, along with their family members if desired, is crucial as they are the focus of care. Choice A is incorrect because it excludes other important members of the healthcare team. Choice B is partially correct as it includes the patient and/or family members but does not encompass the entire healthcare team. Choice C is too broad and does not specifically address the inclusion of the patient or resident. The correct answer, Choice D, includes all healthcare team members and the patient/resident, ensuring a holistic approach to patient-centered care.

3. You are taking care of a patient who has active TB. The patient has been put on airborne precautions and is in a special room. You must wear a HEPA mask when you enter the room. Now, the patient has to leave the room and go to the radiology department. How can you transport this patient to the radiology department without spreading TB throughout the hospital?

• A. Have everyone along the route to the radiology department wear a HEPA mask.
• B. Have patients along the route to the radiology department wear a HEPA mask.
• C. Have staff along the route to the radiology department wear a HEPA mask.
• D. Place a HEPA mask on the patient.

Correct answer: D

Rationale: To prevent the spread of TB throughout the hospital, it is essential to place a HEPA mask on the patient before transporting them to the radiology department. Expecting everyone along the route to wear a HEPA mask is not practical due to the high cost and the need for special fittings. Having patients or staff wear HEPA masks along the route is also not feasible and may not effectively contain the spread of TB.

4. In the Gram Stain procedure, which component acts as the mordant?

• A. Crystal violet
• B. Methyl alcohol
• C. Iodine
• D. Safranin

Correct answer: C

Rationale: In the Gram Stain procedure, the mordant is Gram's Iodine. The purpose of the mordant is to form a complex with the crystal violet, enhancing its ability to bind to the cell wall. Crystal violet is actually the primary stain used in the Gram Stain procedure to initially color all cells. Methyl alcohol is the decolorizer that removes the crystal violet from certain cell types. Safranin is the counterstain used to stain those cells that did not retain the crystal violet stain after the decolorization step.

5. Which of the following puts the layers of skin in the correct order from right to left?

• A. Dermis, epidermis, hypodermis
• B. Hypodermis, epidermis, dermis
• C. Epidermis, dermis, hypodermis
• D. None of the above

Correct answer: C

Rationale: The correct order of the layers of skin from outermost to innermost is the epidermis, dermis, and then the hypodermis. The epidermis is the outermost layer of the skin, followed by the dermis, which is the middle layer containing connective tissue, hair follicles, and sweat glands. The hypodermis, also known as the subcutaneous tissue, lies beneath the dermis and consists of fat and connective tissue. Choice A is incorrect as it lists the layers in the reverse order. Choice B is incorrect as it reverses the order of the layers. Choice D is incorrect as there is a correct answer among the choices.

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