Nursing Elites

1. The nurse is assessing a client with portal hypertension. Which of the following findings would the nurse expect?

• A. Expiratory wheezes
• B. Blurred vision
• C. Ascites
• D. Dilated pupils

Correct answer: C

Rationale: Ascites is a common finding in clients with portal hypertension. Portal hypertension results in increased pressure in the portal vein, leading to the development of ascites, which is the accumulation of fluid in the abdominal cavity. Expiratory wheezes (Choice A) are associated with respiratory conditions. Blurred vision (Choice B) is more commonly linked to eye disorders or neurological issues. Dilated pupils (Choice D) can be related to neurological conditions or drug effects, but not specifically to portal hypertension.

2. Which of the following is the most effective way to prevent the spread of communicable diseases in a community?

• A. Regular health check-ups
• B. Isolation of infected individuals
• C. Immunization programs
• D. Public health education

Correct answer: C

Rationale: Immunization programs are the most effective way to prevent the spread of communicable diseases. Vaccinations help build immunity against specific diseases, reducing the likelihood of an outbreak. Regular health check-ups (Choice A) are important for individual health but do not directly prevent the spread of diseases on a community level. Isolation of infected individuals (Choice B) is a containment measure rather than prevention for the entire community. Public health education (Choice D) is valuable in raising awareness but may not be as effective as immunization programs in directly preventing the spread of communicable diseases.

3. The nurse is caring for a client admitted to the hospital with right lower lobe (RLL) pneumonia. On assessment, the nurse notes crackles over the RLL. The client has significant pleuritic pain and is unable to take in a deep breath in order to cough effectively.

• A. Impaired gas exchange related to acute infection and sputum production
• B. Ineffective airway clearance related to sputum production and ineffective cough
• C. Ineffective breathing pattern related to acute infection
• D. Anxiety related to hospitalization and role conflict

Correct answer: B

Rationale: The client's inability to effectively clear the airway due to pain and sputum production hinders the cough mechanism, making 'Ineffective airway clearance' the most appropriate nursing diagnosis. Although impaired gas exchange may occur due to the pneumonia, the immediate issue is the inability to clear the airway. 'Ineffective breathing pattern' does not address the specific issue of airway clearance. 'Anxiety' is not the priority when the focus should be on the physical complications of pneumonia.

4. During a large community disaster, a man states that the blast threw him out of a second-story window. Which action should the nurse implement first?

• A. Logroll the client to his side and assess for back injuries
• B. Perform a complete neurological assessment
• C. Open the client's airway immediately
• D. Place the nurse's hands around the client's neck to stabilize

Correct answer: D

Rationale: In this situation, the nurse should first stabilize the client's neck to prevent potential spinal cord injuries. Logrolling the client or performing other assessments should only be done after ensuring spinal stabilization. Opening the airway immediately is important in cases of airway obstruction, but stabilizing the neck takes priority in this scenario. Performing a complete neurological assessment may delay immediate stabilization, which is crucial in suspected spinal injuries.

5. When designing a home health care program for disabled children, which factor should be considered when assessing reimbursement for services from private insurance companies?

• A. greater access to any healthcare provider
• B. allowance for early discharge
• C. concern for the quality of care
• D. approval by the network healthcare provider

Correct answer: D

Rationale: When assessing reimbursement for services from private insurance companies, approval by the network healthcare provider is crucial. This approval ensures that the services provided are within the approved network, allowing for reimbursement. Choices A, B, and C are not directly related to the reimbursement process by private insurance companies. While greater access to any healthcare provider, allowance for early discharge, and concern for the quality of care are important considerations when designing a home health care program, they do not specifically impact the reimbursement process from private insurance companies.

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