Nursing Elites

1. The nurse assesses the chest of a patient with pneumococcal pneumonia. Which finding would the nurse expect?

• A. Increased tactile fremitus
• B. Dry, nonproductive cough
• C. Hyperresonance to percussion
• D. A grating sound on auscultation

Correct answer: A

Rationale: Increased tactile fremitus over the area of pulmonary consolidation is expected with bacterial pneumonias, such as pneumococcal pneumonia. Dullness to percussion would be expected due to consolidation. Pneumococcal pneumonia typically presents with a loose, productive cough rather than a dry, nonproductive cough. Hyperresonance to percussion is not a typical finding in pneumonia and may suggest conditions like emphysema. Adventitious breath sounds such as crackles and wheezes are typical in pneumonia, but a grating sound on auscultation is more representative of a pleural friction rub rather than pneumonia.

2. Parents of a 6-month-old breastfed baby ask the nurse about increasing the baby's diet. Which of the following should be added first?

• A. Cereal
• B. Eggs
• C. Meat
• D. Juice

Correct answer: A

Rationale: The correct answer is 'Cereal.' The guidelines of the American Academy of Pediatrics recommend introducing one new food at a time, starting with strained cereal. Cereal is often recommended as a first solid food for infants due to its soft texture and iron-fortified properties, which are important for the baby's development. Eggs and meat are common allergenic foods and are usually introduced later. Juice is not recommended for infants under 1 year old due to its high sugar content and lack of nutritional value compared to whole fruits.

3. Which of the following statements best describes postural drainage as part of chest physiotherapy?

• A. Tapping on the chest wall to loosen secretions
• B. Squeezing the abdomen to increase expansion of the upper chest
• C. Using gravity to move secretions in the lung tissue
• D. Dilating the trachea to facilitate better release of secretions

Correct answer: C

Rationale: Postural drainage is a technique used in chest physiotherapy for clients with accumulated lung secretions. It involves positioning the client to utilize gravity in moving secretions from the lungs. Choice A, tapping on the chest wall, describes percussion, not postural drainage. Choice B, squeezing the abdomen, is not a correct description of postural drainage. Choice D, dilating the trachea, is not related to postural drainage but may be associated with airway clearance techniques.

4. Which fact about diabetes is true?

• A. Only children get type 1 diabetes.
• B. Only adults get type 2 diabetes.
• C. Children and adults can have type 1 diabetes.
• D. Both A and B

Correct answer: C

Rationale: The correct answer is that children and adults can have type 1 diabetes. Although type 1 diabetes is sometimes known as 'childhood diabetes,' it can affect individuals of any age. Type 1 diabetes is not limited to children. While type 2 diabetes is often associated with adults, children can also develop it, especially due to factors like obesity. Choices A and B are incorrect because diabetes is not exclusive to either children or adults; both types of diabetes can affect individuals across different age groups.

5. A patient is diagnosed with both human immunodeficiency virus (HIV) and active tuberculosis (TB) disease. Which information obtained by the nurse is most important to communicate to the healthcare provider?

• A. The Mantoux test induration measured 7 mm.
• B. The chest x-ray revealed infiltrates in the lower lobes.
• C. The patient is receiving antiretroviral therapy for HIV infection.
• D. The patient has a cough producing blood-tinged mucus.

Correct answer: C

Rationale: The most critical information to communicate to the healthcare provider in a patient diagnosed with both HIV and active TB disease is that the patient is receiving antiretroviral therapy for HIV infection. This is crucial because drug interactions can occur between antiretrovirals used to treat HIV infection and medications used to treat TB. By informing the healthcare provider about the antiretroviral therapy, potential interactions can be assessed and managed effectively to optimize patient care. The other data provided, such as the Mantoux test result, chest x-ray findings, and presence of blood-tinged mucus, are important clinical information but are expected in a patient with coexisting HIV and TB and do not directly impact potential drug interactions between antiretrovirals and TB medications.

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