Nursing Elites

1. The nurse is caring for a 27-year-old female client with a venous stasis ulcer. Which nursing intervention would be most effective in promoting healing?

• A. Apply dressing using sterile technique
• B. Improve the client's nutrition status
• C. Initiate limb compression therapy
• D. Begin proteolytic debridement

Correct answer: B

Rationale: Venous stasis occurs when venous blood collects and stagnates in the lower leg due to incompetent venous valves. This leads to inadequate oxygen and nutrient supply to the cells in the lower extremities, resulting in cell death or necrosis. Venous stasis ulcers, characterized by shallow brown wounds with irregular margins, typically develop on the lower leg or ankle. The primary goal in managing clients with venous stasis ulcers is to promote healing. Proper nutrition plays a crucial role in wound healing. Nutritional deficiencies are common causes of venous ulcers, and a diet rich in protein, iron, zinc, and vitamins C and A is recommended to enhance wound healing. Applying dressings with sterile technique, initiating limb compression therapy, and beginning proteolytic debridement are important interventions in wound care but may not directly address the underlying issue of poor nutrition that is essential for healing venous stasis ulcers.

2. A 45-year-old woman is prescribed ropinirole (Requip) for Parkinson's Disease. The patient is living at home with her daughter. The nurse is most concerned about which side effect of ropinirole?

• A. Slurred speech
• B. Sudden dizziness
• C. Mask-like facial expression
• D. Stooped posture

Correct answer: B

Rationale: The correct answer is 'Sudden dizziness.' Dizziness and orthostatic hypotension are serious adverse effects of ropinirole that can lead to an increased risk of falls. Ropinirole belongs to the drug class of dopamine agonists, which mimic dopamine in the brain (Parkinson's Disease is characterized by a lack of dopamine). 'Slurred speech' is not a common side effect of ropinirole. 'Mask-like facial expression' and 'Stooped posture' are more associated with the progression of Parkinson's Disease itself rather than a side effect of ropinirole.

3. Which of the following types of dressing changes works as a form of wound debridement?

• A. Dry dressing
• B. Transparent dressing
• C. Composite dressing
• D. Wet to dry dressing

Correct answer: D

Rationale: The correct answer is 'Wet to dry dressing.' Wet to dry dressing is a method of wound debridement that involves applying sterile soaked gauze to the wound, allowing it to dry and stick to the wound. When the dressing is removed, it pulls away drainage and debris, aiding in wound debridement. Choice A, 'Dry dressing,' does not actively assist in debridement as it does not collect or remove debris from the wound. Choice B, 'Transparent dressing,' is primarily used for maintaining a moist environment and wound observation, not for debridement. Choice C, 'Composite dressing,' combines multiple layers for different wound care purposes but is not specifically designed for debridement like wet to dry dressing.

4. The nurse provides home care instructions to the parents of a child with celiac disease. The nurse should teach the parents to include which food item in the child's diet?

• A. Rice
• B. Oatmeal
• C. Rye toast
• D. White bread

Correct answer: A

Rationale: In celiac disease, individuals are intolerant to gluten found in wheat, barley, rye, and oats. Therefore, it is crucial to eliminate these grains from the diet. Rice, corn, or millet are safe alternatives for individuals with celiac disease. Oatmeal is generally avoided unless specifically labeled as gluten-free due to possible cross-contamination. Rye toast and white bread contain gluten and should be avoided in celiac disease. Vitamin supplements may also be necessary to address deficiencies caused by dietary restrictions.

5. In a pediatric clinic, a nurse is assessing a child recently diagnosed with cystic fibrosis. Which of the following later findings of this disease would the nurse not expect to see at this time?

• A. Positive sweat test
• B. Bulky greasy stools
• C. Moist, productive cough
• D. Meconium ileus

Correct answer: C

Rationale: In a child newly diagnosed with cystic fibrosis (CF), noisy respirations and a dry, non-productive cough are typically the first respiratory signs to appear. The other options, including a positive sweat test, bulky greasy stools, and meconium ileus, are among the earliest findings of CF. CF is a genetic condition that affects the production of mucus, sweat, saliva, and digestive juices. Due to a defective gene, these secretions become thick and sticky instead of thin and slippery, leading to blockages in various passageways, especially in the pancreas and lungs. Respiratory failure is a severe consequence of CF, making it crucial to monitor respiratory symptoms closely in affected individuals. Therefore, a moist, productive cough would not be an expected finding in a newly diagnosed child with CF.

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