Nursing Elites

1. The home health nurse visits a male client to provide wound care and finds the client lethargic and confused. His wife states he fell down the stairs two (2) hours ago. The nurse should

• A. Place a call to the client's healthcare provider for instructions
• B. Send him to the emergency room for evaluation
• C. Reassure the client's wife that the symptoms are transient
• D. Instruct the client's wife to call the doctor if his symptoms become worse

Correct answer: B

Rationale: In this scenario, the client is presenting with concerning symptoms of lethargy and confusion after a fall. These symptoms could indicate a serious underlying issue, such as a head injury or internal bleeding. The nurse's priority is to ensure the client receives immediate evaluation and treatment to prevent any further harm. Option B is the correct choice as it emphasizes the urgency of the situation. Choices A, C, and D are incorrect because they do not address the critical nature of the client's condition. Contacting the healthcare provider, reassuring the wife, or waiting for symptoms to worsen could delay necessary medical intervention.

2. A patient with severe Gastroesophageal Reflux Disease is receiving discharge teaching. Which of these statements by the patient indicates a need for more teaching?

• A. ''I'm going to limit my meals to 2-3 per day to reduce acid secretion.''
• B. ''I'm going to make sure to remain upright after meals and elevate my head when I sleep.''
• C. ''I won't be drinking tea or coffee or eating chocolate anymore.''
• D. ''I'm going to start trying to lose some weight.''

Correct answer: A

Rationale: The correct answer is ''I'm going to limit my meals to 2-3 per day to reduce acid secretion.'' This statement indicates a need for more teaching because large meals increase the volume and pressure in the stomach, delaying gastric emptying, and worsening symptoms of Gastroesophageal Reflux Disease (GERD). The recommended approach is to eat smaller, more frequent meals (4-6 small meals a day) to reduce acid reflux. Choices B, C, and D demonstrate good understanding of GERD management by highlighting the importance of staying upright after meals, avoiding trigger foods like tea, coffee, and chocolate, and addressing weight management, which are all appropriate strategies to manage GERD symptoms.

3. A 67-year-old male patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. Which information obtained by the nurse indicates that these therapies have been effective?

• A. Bowel sounds are present.
• B. Grey Turner sign resolves.
• C. Electrolyte levels are normal.
• D. Abdominal pain is decreased.

Correct answer: D

Rationale: The correct answer is 'Abdominal pain is decreased.' In a patient with acute pancreatitis, the goal of using an NG tube for suction and keeping the patient NPO is to decrease the release of pancreatic enzymes and alleviate pain. Therefore, a decrease in abdominal pain would indicate the effectiveness of these therapies. Bowel sounds being present do not necessarily indicate treatment effectiveness, as they can still be present even if the therapies are not fully effective. Normal electrolyte levels are important but do not directly reflect the efficacy of NG suction and NPO status. The resolution of Grey Turner sign, a bruising over the flanks associated with pancreatitis, is a late and non-specific finding and waiting for it to resolve is not a reliable indicator of treatment effectiveness.

4. A patient's chart indicates a history of meningitis. Which of the following would you NOT expect to see with this patient if this condition were acute?

• A. Increased appetite
• B. Vomiting
• C. Fever
• D. Poor tolerance of light

Correct answer: A

Rationale: The correct answer is 'Increased appetite.' In cases of acute meningitis, loss of appetite would be expected rather than an increase. Meningitis is often caused by an infectious agent that colonizes or infects various sites in the body, leading to systemic symptoms. Common symptoms of acute meningitis include fever, vomiting, and poor tolerance of light due to meningeal irritation. The inflammatory response in the meninges can result in symptoms like photophobia. Increased appetite is not typically associated with acute meningitis. Therefore, choice A is the least likely symptom to be observed in a patient with acute meningitis. Choices B, C, and D are symptoms commonly seen in acute meningitis due to the inflammatory process affecting the central nervous system and meninges.

5. A patient has come into the emergency room after an injury at work in which their upper body was pinned between two pieces of equipment. The nurse notes bruising in the upper abdomen and chest. The patient is complaining of sharp chest pain, having difficulty breathing, and their trachea is deviated to the left side. Which of the following conditions are these symptoms most closely associated with?

• A. Left-sided pneumothorax
• B. Pleural effusion
• C. Atelectasis
• D. Right-sided pneumothorax

Correct answer: D

Rationale: The patient is most likely suffering from a right-sided pneumothorax. Symptoms of a pneumothorax include sharp chest pain, difficulties with breathing, decreased vocal fremitus, absent breath sounds, and tracheal shift to the opposite of the affected side. In this case, the patient's trachea is deviated to the left side, indicating a right-sided pneumothorax. Choices A, B, and C can be eliminated as they do not present with the specific symptoms described in the scenario. Left-sided pneumothorax would not cause tracheal deviation to the left side. Pleural effusion typically presents with dull chest pain and decreased breath sounds, not sharp chest pain and tracheal deviation. Atelectasis would not cause tracheal deviation and is more associated with lung collapse rather than air accumulation in the pleural space.

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