Nursing Elites

1. The nurse is assessing an infant with developmental dysplasia of the hip. Which finding would the nurse anticipate?

• A. Unequal leg length
• B. Limited adduction
• C. Diminished femoral pulses
• D. Symmetrical gluteal folds

Correct answer: A

Rationale: In developmental dysplasia of the hip (DDH), one of the key findings is unequal leg length. This occurs due to the dislocation of the hip joint, where the ball is loose in the socket. Limited adduction, the inability to bring the hip and knee towards the midline of the body, is also a common finding in DDH. Diminished femoral pulses are not typically associated with DDH, as it primarily affects the skeletal structure rather than vascular supply. Symmetrical gluteal folds are normal in infants and do not indicate DDH, as asymmetry in gluteal folds can be a sign of hip dislocation.

2. A client is admitted to the emergency room with renal calculi and is complaining of moderate to severe flank pain and nausea. The client's temperature is 100.8 degrees Fahrenheit. The priority nursing goal for this client is:

• A. Maintain fluid and electrolyte balance
• B. Control nausea
• C. Manage pain
• D. Prevent urinary tract infection

Correct answer: C

Rationale: In the scenario presented, the priority nursing goal for a client with renal calculi experiencing moderate to severe flank pain and nausea should be to manage pain. Pain management is crucial as it alleviates suffering, improves comfort, and enhances the quality of life for the client. In the case of ureteral colic from renal calculi, the cornerstone of management is effective pain control. Prompt analgesia, typically achieved with parenteral narcotics or nonsteroidal anti-inflammatory drugs (NSAIDs), is essential to provide relief and facilitate the passage of the calculi. While maintaining fluid and electrolyte balance is important in clients with renal calculi, addressing pain takes precedence as it directly impacts the client's immediate well-being. Controlling nausea and preventing urinary tract infections are also important aspects of care, but they are secondary to managing the primary concern of pain in this urgent situation.

3. A patient diagnosed with epilepsy is receiving discharge education from a nurse. Which of the following teachings should be emphasized the most?

• A. Avoid consuming alcohol and drugs
• B. Adhere to follow-up appointments with the neurologist, physician, or other healthcare provider as directed
• C. Continue taking anticonvulsants, even if seizures have ceased
• D. Wear a medical alert bracelet or carry an ID card indicating epilepsy

Correct answer: C

Rationale: The most critical teaching that the nurse should stress to a patient with epilepsy is to continue taking anticonvulsants even if seizures have stopped. Suddenly stopping antiepileptic drugs can lead to seizures and an increased risk of status epilepticus, a life-threatening condition. Choice A, advising to avoid alcohol and drugs, is important but not as crucial as maintaining anticonvulsant therapy. Choice B, emphasizing follow-up appointments, is essential but ensuring medication compliance is more critical to prevent seizure recurrence. Choice D, wearing a medical alert bracelet, is important for emergency identification but does not directly impact the patient's immediate safety like medication adherence does.

4. You have accompanied the physician into the family waiting room to tell a young husband that his wife has not survived the car accident she was in. The husband is crying and distraught. What is the most appropriate approach to supporting this family member?

• A. Ask if he would like to donate his wife's organs
• B. Sit quietly with him
• C. Ask about funeral arrangements
• D. Consult social services

Correct answer: B

Rationale: The most caring and supportive approach in a time of extreme distress is usually to sit quietly with the distressed individual until they have had the opportunity to absorb the news and gather themselves. Providing a supportive presence is often the most valuable tool a caregiver can use when circumstances bring overwhelming emotional pain to those they are caring for. Asking about organ donation at this moment may come off as insensitive and should not be a priority. Inquiring about funeral arrangements and consulting social services can be addressed later, once the husband has had time to process the initial shock and emotions.

5. An alcoholic and homeless patient is diagnosed with active tuberculosis (TB). Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen?

• A. Arrange for a friend to administer the medication on schedule.
• B. Give the patient written instructions about how to take the medications.
• C. Teach the patient about the high risk for infecting others unless treatment is followed.
• D. Arrange for a daily noon meal at a community center where the drug will be administered

Correct answer: D

Rationale: Directly observed therapy is the most effective means for ensuring compliance with the treatment regimen for a homeless patient with active tuberculosis. By arranging a daily noon meal at a community center where the drug will be administered, the nurse ensures that the patient is available to receive the medication and can directly observe the patient taking it. This method helps address the challenges faced by homeless individuals, such as lack of a stable living situation. The other options, such as having a friend administer the medication, giving written instructions, or educating about infecting others, may not be as effective in ensuring adherence, especially in the case of a homeless individual with alcoholism.

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