Nursing Elites

1. Sinusitis is caused by:

• A. Bacteria
• B. Fungus
• C. Virus
• D. Any of the above

Correct answer: D

Rationale: Sinusitis can be caused by bacteria, viruses, or fungi. While bacterial infections are the most common cause, viral or fungal infections can also lead to sinusitis. Therefore, the correct answer is 'Any of the above.' Choices A, B, and C are incorrect because they only represent individual causes of sinusitis, whereas choice D encompasses all possible causes.

2. Ruth is a 72-year-old patient who has been upset and crying all morning. When asked why she is upset, she turns toward the wall in silence. What collaborative process may be helpful in caring for this patient?

• A. Speak with the patient care technician
• B. Call the chaplain
• C. Call the social worker
• D. Call the patient's husband

Correct answer: A

Rationale: Collaborating with the patient care technician is an appropriate approach in this scenario. Patient care technicians and nurses' aides often provide direct care to patients, developing a closer relationship with them. Patients may feel more comfortable sharing their feelings with these caregivers compared to other healthcare professionals. In this situation, Ruth's distress appears more emotional than spiritual, making it more suitable to speak with someone directly involved in her care. Calling the chaplain (Choice B) might not directly address Ruth's immediate emotional needs as it could focus more on spiritual support. Involving the social worker (Choice C) could help address underlying emotional or social issues, but speaking with the patient care technician is a more direct and immediate step to assess and provide initial support. Calling the patient's husband (Choice D) may not address Ruth's immediate emotional distress and may not be appropriate without understanding the root cause of her upset.

3. A nurse is caring for a 3-day old infant who needs an exchange transfusion. Which of the following statements is appropriate for teaching the child's parents about this procedure?

• A. The registered nurse will be performing the procedure
• B. The procedure takes approximately 1 ? hours.
• C. The nurse will draw out 250cc of blood and then immediately replace it with 250cc
• D. The infant will continue to receive phototherapy during the procedure.

Correct answer: B

Rationale: : An exchange transfusion is a method of controlling high bilirubin levels in infants when traditional phototherapy is unsuccessful. During an exchange transfusion, the physician removes 5-10 cc of blood and then replaces it with donor blood. The parents of this infant should know that the procedure is always performed by a physician and will take approximately 1 ½ hours to complete.

4. Which of the following conditions increases a client's risk of aspiration of stomach contents?

• A. A client is in restraints
• B. A client has a scaphoid abdomen
• C. A client is lying prone
• D. More than one answer is correct

Correct answer: A

Rationale: A client in restraints is at an increased risk of aspiration of stomach contents. When a client is restrained, they may be unable to effectively move or turn their body if they begin to vomit, which can lead to aspiration. This lack of mobility can hinder their ability to protect their airway. On the other hand, a scaphoid abdomen, which is sunken or hollowed, is not a direct risk factor for aspiration. Additionally, lying prone, facing downward, does not necessarily increase the risk of aspiration, as aspiration is more likely when lying supine (facing upward). Therefore, the correct answer is that a client is in restraints.

5. You are caring for a group of elderly clients, many of whom are affected by multiple chronic disorders and are also, at times, affected by some acute disorders that require medical and nursing attention. As you are caring for these clients, some will need a new medication regimen for an acute disorder. You should consider the fact that the elderly population is at risk for more side effects, adverse drug reactions, and toxicity due to the elderly having a(n):

• A. Increased creatinine clearance.
• B. Impaired immune system.
• C. Decreased hepatic metabolism.
• D. Increased bodily fat

Correct answer: C

Rationale: The correct answer is 'Decreased hepatic metabolism.' The elderly population is at risk for more side effects, adverse drug reactions, and toxicity due to a decrease in hepatic metabolism. This is caused by changes in hepatic functioning in the elderly, including decreased hepatic blood flow and functioning. Choice A, 'Increased creatinine clearance,' is incorrect as aging typically results in decreased, not increased, creatinine clearance. Choice B, 'Impaired immune system,' is not directly related to the increased risk of adverse drug reactions in the elderly. Choice D, 'Increased bodily fat,' is not a primary factor contributing to the increased risk of medication-related issues in the elderly population.

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