Nursing Elites

1. What is the cause of meningitis that is fatal in half of the infected patients?

• A. Virus
• B. Bacteria
• C. Fungus
• D. Noninfectious agent

Correct answer: B

Rationale: Bacterial meningitis is caused by bacterial pathogens such as Streptococcus pneumoniae, Haemophilus influenzae, Listeria monocytogenes, and Neisseria meningitidis. These bacteria commonly lead to acute onset meningitis, presenting with symptoms like fever, stiff neck, and altered consciousness. The statement that bacterial meningitis is fatal in about 50% of cases is accurate, making it a serious and life-threatening condition. Viruses can also cause meningitis, but they are not typically associated with the high fatality rate seen in bacterial meningitis. Fungal meningitis is less common and usually affects individuals with weakened immune systems. Noninfectious agents do not cause meningitis.

2. A client is in her third month of her first pregnancy. During the interview, she tells the nurse that she has several sex partners and is unsure of the identity of the baby's father. Which of the following nursing interventions is a priority?

• A. Counsel the woman to consent to HIV screening.
• B. Perform tests for sexually transmitted diseases.
• C. Discuss her high risk for cervical cancer.
• D. Refer the client to a family planning clinic.

Correct answer: A

Rationale: In this scenario, the client's disclosure of having multiple sex partners and uncertainty about the baby's father indicates a potential high risk for HIV. Therefore, the priority nursing intervention is to counsel the woman to consent to HIV screening. Early detection of HIV is crucial for initiating timely treatment and improving outcomes. Choices B, C, and D are not the priority in this situation as HIV screening takes precedence over testing for other sexually transmitted diseases, discussing cervical cancer risk, or referring to a family planning clinic.

3. After 2 months of tuberculosis (TB) treatment with isoniazid (INH), rifampin (Rifadin), pyrazinamide (PZA), and ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should the nurse take next?

• A. Teach about drug-resistant TB treatment
• B. Ask the patient whether medications have been taken as directed
• C. Schedule the patient for directly observed therapy three times weekly
• D. Discuss with the healthcare provider the need for the patient to use an injectable antibiotic

Correct answer: B

Rationale: The first action should be to determine whether the patient has been compliant with drug therapy because negative sputum smears would be expected if the TB bacillus is susceptible to the medications and if the medications have been taken correctly. Assessment is the first step in the nursing process. Depending on whether the patient has been compliant or not, different medications or directly observed therapy may be indicated. The other options are interventions based on assumptions until an assessment has been completed. Teaching about drug-resistant TB treatment (Choice A) is premature without knowing the current medication compliance status. Scheduling directly observed therapy (Choice C) assumes non-compliance without confirming it first. Discussing the need for an injectable antibiotic (Choice D) is premature and not necessarily indicated without assessing the current medication adherence.

4. A client is in the post-anesthesia care unit (PACU) shivering despite being covered with several layers of blankets. What is the nurse's next action?

• A. Turn the client to the prone position
• B. Assist the client in breathing deeply
• C. Administer meperidine as ordered
• D. None of the above

Correct answer: C

Rationale: In the post-anesthesia care unit, clients may experience shivering or chills due to a drop in body temperature after surgery. Meperidine (Demerol) can be prescribed to alleviate shivering in cold clients. The prone position (lying face down) and deep breathing exercises are not interventions specifically indicated for addressing shivering due to low body temperature. Therefore, administering meperidine as ordered is the most appropriate action to manage the client's shivering in this scenario.

5. The nurse prepares a patient with a left-sided pleural effusion for a thoracentesis. How should the nurse position the patient?

• A. Supine with the head of the bed elevated 30 degrees
• B. In a high-Fowler's position with the left arm extended
• C. On the right side with the left arm extended above the head
• D. Sitting upright with the arms supported on an overbed table

Correct answer: D

Rationale: The correct position for a patient with a left-sided pleural effusion undergoing thoracentesis is sitting upright with the arms supported on an overbed table. This position helps increase lung expansion, allows fluid to collect at the lung bases, and expands the intercostal space making access to the pleural space easier. Placing the patient supine, in a high-Fowler's position, or on the right side with the left arm extended above the head could increase the work of breathing for the patient and complicate the thoracentesis procedure for the healthcare provider.

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