Nursing Elites

1. A client has pharyngeal diphtheria. What transmission precautions are necessary?

• A. Droplet
• B. Contact
• C. Airborne
• D. Standard

Correct answer: A

Rationale: Pharyngeal diphtheria is primarily spread through droplet transmission, which occurs when an infected person coughs, sneezes, or talks, releasing respiratory droplets containing the bacteria. Therefore, the correct precaution for caring for a client with pharyngeal diphtheria is droplet precautions. Droplet precautions help prevent the transmission of respiratory pathogens over short distances via respiratory droplets. Contact precautions are used for diseases spread through direct or indirect contact with the patient or their environment. Airborne precautions are used for diseases that spread through small droplets suspended in the air. Standard precautions are basic infection prevention practices applying to all patient care.

2. The healthcare provider is assessing a client diagnosed with rheumatoid arthritis. Which assessment finding would be most concerning?

• A. Morning stiffness
• B. Joint deformities
• C. Weight loss
• D. Fever

Correct answer: D

Rationale: Fever in a client with rheumatoid arthritis can indicate an underlying infection or a more serious systemic involvement, such as vasculitis or inflammation of internal organs. These conditions can lead to serious complications and require immediate medical attention. Joint deformities and morning stiffness are common manifestations of rheumatoid arthritis itself and may not be indicative of an acute issue. Weight loss can be seen in chronic inflammatory conditions like rheumatoid arthritis but is not as concerning as fever, which suggests an acute process requiring prompt evaluation and intervention.

3. The healthcare provider is assessing a client with a history of congestive heart failure. Which assessment finding would be most concerning?

• A. Shortness of breath on exertion
• B. Weight gain of 2 pounds in a week
• C. Orthopnea
• D. Crackles in the lungs

Correct answer: D

Rationale: Crackles in the lungs are concerning because they indicate pulmonary congestion, a serious complication of congestive heart failure. The presence of crackles suggests fluid accumulation in the lungs, requiring immediate attention to prevent respiratory distress and worsening heart failure. While shortness of breath on exertion, weight gain, and orthopnea are common signs and symptoms of heart failure, crackles specifically point to acute pulmonary edema or worsening congestion, making them the most concerning finding in this scenario.

4. A client who has a new prescription for warfarin (Coumadin) is receiving discharge instructions. Which statement indicates the client understands the teaching?

• A. I will take my warfarin at the same time every day.
• B. I should increase my intake of green leafy vegetables.
• C. I should use a soft-bristled toothbrush while taking this medication.
• D. I should avoid drinking alcohol while taking this medication.

Correct answer: C

Rationale: The correct answer is C: 'I should use a soft-bristled toothbrush while taking this medication.' Using a soft-bristled toothbrush is crucial as it helps prevent bleeding gums, which is a potential side effect of warfarin therapy. Option A about taking warfarin at the same time every day is a good practice but does not directly relate to preventing side effects. Option B suggesting an increase in green leafy vegetables can interfere with warfarin's anticoagulant effects due to their vitamin K content. Option D advising to avoid alcohol is generally recommended but is not directly related to the specific side effects of warfarin.

5. A middle adult client tells the nurse, 'I feel so useless now that my children do not need me anymore.' Which of the following responses should the nurse make?

• A. People in middle adulthood often find satisfaction in nurturing and guiding young people.
• B. It's normal to feel this way; it will pass.
• C. You should focus on finding new activities to fill your time.
• D. Your children will always need you in some way.

Correct answer: A

Rationale: The correct response is A. Middle adulthood is a stage where individuals often experience generativity, finding fulfillment in guiding and nurturing others. By acknowledging this aspect, the nurse can help the client explore opportunities to engage in activities that provide a sense of purpose and satisfaction. Choice A validates the client's feelings and offers a constructive way to address them. Choices B, C, and D do not address the client's emotional need for purpose and may not encourage the client to seek meaningful ways to address their feelings of uselessness.

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