Nursing Elites

1. One of the complications of complete bed rest and immobility is which of the following?

• A. Plantar flexion
• B. Dorsiflexion
• C. Extension contractures
• D. Adduction contractures

Correct answer: A

Rationale: Plantar flexion, or foot drop, is a common complication of complete bed rest and immobility. This condition occurs due to the weakening of muscles that lift the foot, leading to the foot dragging or being unable to clear the ground during walking. Dorsiflexion refers to moving the foot upwards, which is not a typical complication of immobility. Extension contractures involve the inability to fully extend a joint, while adduction contractures refer to the inability to move a limb away from the body. These types of contractures can also occur with immobility, but they are not specifically associated with foot drop.

2. A patient with peripheral vascular disease is receiving discharge instructions. Which of the following information should be included?

• A. Walk barefoot whenever possible.
• B. Use a heating pad to keep feet warm.
• C. Avoid crossing the legs.
• D. Use antibacterial ointment to treat skin lesions prone to infection.

Correct answer: C

Rationale: Patients with peripheral vascular disease should be advised to avoid crossing their legs as this can impede blood flow. Peripheral vascular disease, also known as arteriosclerosis obliterans, is primarily caused by atherosclerosis. Atherosclerosis results in the gradual progression of arterial occlusion due to the formation of atheromas. Crossed legs can further restrict blood flow, exacerbating the condition. Walking barefoot should be discouraged to prevent potential injuries to the feet. Using a heating pad can lead to burns and should be avoided to prevent thermal injuries. While using antibacterial ointment for skin lesions may be beneficial, it is not the priority instruction for patients with peripheral vascular disease.

3. A nurse is required to float to another unit within the hospital where he is asked to care for a client on a ventilator. The nurse is uncomfortable with this assignment, as he has not had a ventilated client since nursing school. What is the nurse's most appropriate response?

• A. Explain to the nursing supervisor the level of discomfort and ask for a different assignment
• B. State that the client's needs are outside the nurse's scope of practice and request a different assignment
• C. Accept the assignment, asking for help when necessary
• D. Request to return to the home unit and send another nurse who can perform the job

Correct answer: A

Rationale: When floating to another unit and asked to take an assignment that falls outside a nurse's comfort zone, the nurse should notify the area supervisor of the level of discomfort and request a different assignment. Caring for ventilated clients typically falls within the scope of nursing practice; however, discomfort with the situation may not necessarily be overcome by accepting the assignment. Alternatively, the effects could be harmful to the client if the nurse is unfamiliar with this type of care. Requesting a different assignment is the most appropriate response in this situation, ensuring patient safety and the nurse's comfort level. Stating that the client's needs are outside the nurse's scope of practice (Choice B) may not be accurate, as caring for ventilated clients usually falls within the scope of nursing practice. Accepting the assignment (Choice C) without addressing the discomfort may compromise patient safety. Requesting to return to the home unit (Choice D) does not address the immediate need of caring for the ventilated client and may delay appropriate care.

4. A writer is admitted for the second time accompanied by his wife. He is demanding, arrogant, talks fast, and is hyperactive. Initially, the nurse should plan this for a manic client:

• A. Set realistic limits to the client's behavior
• B. Repeat verbal instructions as often as needed
• C. Allow the client to express feelings to relieve tension
• D. Assign a staff member to be with the client at all times to help maintain control

Correct answer: A

Rationale: For a manic client who is demanding, arrogant, talks fast, and is hyperactive, setting realistic limits to the client's behavior is essential to ensure safety as manic clients may engage in injurious activities. A quiet environment and consistent, firm limits help to maintain control. While repeating verbal instructions may be necessary due to distractibility, it is not the priority compared to setting limits for safety. Allowing the client to express feelings is important, but only non-destructive methods of expression should be permitted. Assigning a staff member to be with the client at all times is not a realistic approach as it may not always be feasible or necessary for managing manic behavior effectively.

5. Mrs. F has been diagnosed with hyperparathyroidism. Which of the following complications is Mrs. F at highest risk of developing?

• A. Hyponatremia
• B. Hypocalcemia
• C. Hypermagnesemia
• D. Hypercalcemia

Correct answer: D

Rationale: The parathyroid glands regulate calcium, vitamin D, and phosphorus in the body. Hyperparathyroidism leads to excessive production of parathyroid hormone, causing the release of calcium from bones into the bloodstream, resulting in elevated blood calcium levels, known as hypercalcemia. This puts individuals at risk of developing complications such as kidney stones, bone pain, osteoporosis, and neuropsychiatric symptoms. The other options, hyponatremia, hypocalcemia, and hypermagnesemia, are not directly associated with hyperparathyroidism. Hyponatremia is low sodium levels in the blood, hypocalcemia is low calcium levels, and hypermagnesemia is high magnesium levels, which are not typically seen in hyperparathyroidism.

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