Nursing Elites

1. The LPN is caring for a client newly diagnosed with HIV. Which statement made by the client regarding antiretroviral therapy (ART) would require correction from the nurse?

• A. "If I start ART and use condoms, I'm less likely to transmit HIV to my partner."?
• B. "I can still use ART even though I am Hepatitis C positive."?
• C. "I will need to be on ART indefinitely."?
• D. "I know I will need to come back for blood draws so that I can begin ART when my CD4 count is over 1,000 cells/mm3."?

Correct answer: D

Rationale: The correct answer is the statement, "I know I will need to come back for blood draws so that I can begin ART when my CD4 count is over 1,000 cells/mm3."? This statement would require correction from the nurse because initiating ART when the CD4 count is over 1,000 cells/mm3 is not supported by guidelines. The World Health Organization (WHO) recommends making treatment a priority for those with a CD4 count of ?350 cells/mm3, as early intervention can help delay disease progression. Therefore, waiting for a CD4 count of over 1,000 cells/mm3 is not in line with current recommendations. Choice A is correct, as studies have shown that using condoms along with ART can significantly reduce the risk of HIV transmission to sexual partners. Choice B is also correct because being Hepatitis C positive does not contraindicate the use of ART. Choice C is correct as well, as ART is typically needed indefinitely to maintain viral suppression and manage HIV. Therefore, the only statement that would require correction is Choice D.

2. Assisting with data collection, a nurse notes tenderness while lightly palpating a client's right lower quadrant of the abdomen. The nurse determines that this finding is most likely associated with which anatomic structure?

• A. Liver
• B. Spleen
• C. Pancreas
• D. Appendix

Correct answer: D

Rationale: The correct answer is the Appendix. Tenderness in the right lower quadrant of the abdomen is a classic sign of appendicitis, which is inflammation of the appendix. The appendix is located in the right lower quadrant. The other choices are incorrect. The spleen is located on the posterolateral wall of the abdominal cavity under the diaphragm. The pancreas is located behind the stomach. The liver fills most of the right upper quadrant and extends to the left midclavicular line.

3. During data collection of a client with suspected carpal tunnel syndrome, a nurse plans to perform the Phalen test. The nurse should ask the client to perform which activity?

• A. Dorsiflex the foot
• B. Plantarflex the foot
• C. Hold the hands back to back while flexing the wrists 90 degrees for 60 seconds
• D. Hyperextend the fingers with the palmar surfaces of the hands touching, holding the position for 60 seconds

Correct answer: C

Rationale: In the Phalen test, the nurse asks the client to hold the hands back to back while flexing the wrists 90 degrees. This position puts pressure on the median nerve, eliciting symptoms in carpal tunnel syndrome. Dorsiflexing or plantarflexing the foot and hyperextending the fingers are not associated with testing for carpal tunnel syndrome. Acute flexion of the wrist for 60 seconds produces no symptoms in the normal hand.

4. When testing the function of the oculomotor, trochlear, and abducens nerves, which parameter does a nurse check to determine their function?

• A. Tongue symmetry
• B. Eye movements
• C. Facial symmetry
• D. Corneal reflex

Correct answer: B

Rationale: The correct answer is B: Eye movements. When assessing the oculomotor, trochlear, and abducens nerves, evaluating eye movements is crucial. This assessment includes checking the pupils for size, regularity, equality, light reactions, accommodation, and extraocular movements in various gaze positions. Tongue symmetry is primarily used to evaluate cranial nerve XII (hypoglossal nerve) function. Facial symmetry is a key indicator of cranial nerve VII (facial nerve) function. The corneal reflex assesses sensory afferents in cranial nerve V (trigeminal nerve) and motor efferents in cranial nerve VII (facial nerve).

5. When evaluating a kinetic family drawing, which of the following actions is most effective?

• A. asking the child to draw their family doing something
• B. offering specific suggestions of what to include in the drawing
• C. discouraging the child from talking about the drawing
• D. noting the omission of any family members

Correct answer: D

Rationale: When evaluating a kinetic family drawing, noting the omission of any family members is an effective action. It is crucial to observe and analyze all aspects of the drawing, including what is missing. This can provide valuable insights into the child's perception and relationships within the family. Asking the child to draw their family doing something (Choice A) is more related to initial instruction rather than evaluation. Offering specific suggestions (Choice B) can influence the child's drawing and should be avoided to maintain the authenticity of the representation. Discouraging the child from talking about the drawing (Choice C) is counterproductive as verbal expression can provide additional context and understanding.

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