Nursing Elites

1. Signs of impaired breathing in infants and children include all of the following except:

• A. nasal flaring
• B. grunting
• C. seesaw breathing
• D. quivering lips

Correct answer: D

Rationale: Signs of impaired breathing in infants and children can manifest in various ways. Nasal flaring, grunting, and seesaw breathing are all indicative of respiratory distress in pediatric patients. Nasal flaring is the widening of the nostrils with breathing effort, grunting is a sound made during exhalation to try to keep the airways open, and seesaw breathing involves the chest moving in the opposite direction of the abdomen. However, quivering lips are not typically associated with impaired breathing in this context. Lip quivering is a distracter and not a common sign of respiratory distress in infants and children. Therefore, the correct answer is 'quivering lips.'

2. A client is admitted to telemetry with a diagnosis of diabetes at 3pm. At 10pm, the client is unresponsive. BP is 98/64, Resp 38, HR 100, T 97. The nurse notes a fruity smell on the client's breath. The nurse recognizes that the client is in which acid-base imbalance?

• A. Respiratory acidosis
• B. Respiratory alkalosis
• C. Metabolic acidosis
• D. Metabolic alkalosis

Correct answer: C

Rationale: Based on the client's unresponsiveness, fruity breath smell, and the presence of diabetes, the nurse can infer that the client is experiencing diabetic ketoacidosis (DKA). DKA is a complication of diabetes characterized by the accumulation of ketones in the body, leading to metabolic acidosis. The fruity breath smell is due to the presence of ketones. Therefore, the correct acid-base imbalance in this scenario is metabolic acidosis. Choice A, respiratory acidosis, is incorrect because the scenario does not provide evidence of primary respiratory dysfunction. Choice B, respiratory alkalosis, is incorrect as the client's condition does not align with the typical causes and symptoms of respiratory alkalosis. Choice D, metabolic alkalosis, is incorrect as the symptoms and history provided do not suggest a state of metabolic alkalosis.

3. Which of the following microorganisms is easily transmitted from client to client on the hands of healthcare workers?

• A. mycobacterium tuberculosis
• B. clostridium tetani
• C. staphylococcus aureus
• D. human immunodeficiency virus

Correct answer: C

Rationale: The correct answer is staphylococcus aureus. Staphylococcus aureus microorganisms are ubiquitous and easily transmitted by healthcare workers who fail to conduct routine hand washing between clients. Staphylococcus aureus can reside on the skin and be transferred from one client to another if proper hand hygiene is not practiced. Mycobacterium tuberculosis is mainly transmitted through the airborne route, clostridium tetani is usually acquired through exposure to soil or dirt contaminated with tetanus spores, and human immunodeficiency virus is not easily transmitted through casual contact or on the hands of healthcare workers.

4. What advice should be given to a client with stress incontinence?

• A. to consider trying Kegel exercises
• B. to undergo surgery immediately
• C. to avoid all forms of treatment
• D. to ignore the issue as it is not serious

Correct answer: A

Rationale: For stress incontinence, advising the client to consider trying Kegel exercises is appropriate. Kegel exercises involve tightening and releasing the pelvic floor muscles, which can improve stress incontinence by strengthening the muscles that control urination. Choice B suggesting immediate surgery is incorrect as surgery is usually considered after conservative treatments like Kegel exercises have been tried. Choice C advising to avoid all forms of treatment is dangerous and neglectful. Choice D recommending to ignore the issue is inappropriate as it can impact the client's quality of life and may worsen over time without intervention.

5. What is the primary sign of displacement following a total hip replacement?

• A. pain on movement and weight bearing
• B. hemorrhage
• C. affected leg appearing 1-2 inches longer
• D. edema in the area of the incision

Correct answer: A

Rationale: The correct answer is pain on movement and weight bearing. This pain is the primary sign of prosthesis displacement after a total hip replacement, indicating pressure on nerves or muscles due to dislocation. Hemorrhage is not typically associated with prosthesis displacement. While the affected leg may appear longer, this is not the primary sign of displacement; it might actually be shorter due to muscle spasm. Edema in the incision area is not a primary indicator of prosthesis displacement.

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