Nursing Elites

1. The nurse is planning care for a client with increased intracranial pressure. The best position for this client is

• A. Trendelenburg
• B. Prone
• C. Semi-Fowler's
• D. Side-lying with head flat

Correct answer: C

Rationale: The correct answer is C, Semi-Fowler's. This position helps to reduce intracranial pressure by promoting venous drainage from the head while maintaining adequate oxygenation. Option A, Trendelenburg position, is incorrect as it involves placing the patient with the head lower than the body, which can increase intracranial pressure. Option B, Prone position, is also incorrect as it involves lying on the stomach, which can further elevate intracranial pressure. Option D, Side-lying with head flat, does not provide the same benefits as the Semi-Fowler's position in terms of promoting venous drainage and maintaining oxygenation in a client with increased intracranial pressure.

2. What does the term 'vital statistics' refer to?

• A. The systematic study of vital events such as births, illnesses, marriages, divorce, separation, and deaths
• B. Morbidity
• C. Statistics
• D. Mortality

Correct answer: A

Rationale: The term 'vital statistics' specifically refers to the systematic study of vital events, including births, illnesses, marriages, divorces, separations, and deaths. This field focuses on quantifying and analyzing these essential life events within a population. Choices B, C, and D are incorrect because while they may be related to data collection and analysis, they do not encompass the broad spectrum of vital events covered under the term 'vital statistics.' Morbidity refers to the prevalence of a specific illness or disease within a population, statistics is a more general term for numerical data analysis, and mortality specifically pertains to deaths within a population.

3. Which of the following is a major focus of tertiary prevention?

• A. Preventing the onset of disease
• B. Early detection and treatment
• C. Reducing the impact of an ongoing illness
• D. Health education

Correct answer: C

Rationale: The correct answer is C, 'Reducing the impact of an ongoing illness.' Tertiary prevention aims to minimize the effects of a disease or condition that is already established. Choices A, 'Preventing the onset of disease,' and B, 'Early detection and treatment,' are aspects of primary and secondary prevention, respectively. Choice D, 'Health education,' is more related to promoting awareness and knowledge rather than specifically focusing on reducing the impact of an ongoing illness.

4. As a client who is terminally ill has been receiving high doses of an opioid analgesic for the past month and becomes unresponsive to verbal stimuli as death approaches, what orders would the nurse expect from the healthcare provider?

• A. Decrease the analgesic dosage by half
• B. Discontinue the analgesic
• C. Continue the same analgesic dosage
• D. Prescribe a less potent drug

Correct answer: C

Rationale: Continuing the same dosage of analgesic is appropriate to manage pain effectively as death nears and the client becomes unresponsive. The primary goal of palliative care in end-of-life situations is to ensure comfort, regardless of the client's level of consciousness. Decreasing the analgesic dosage or discontinuing it could lead to inadequate pain relief, which goes against the principles of palliative care. Prescribing a less potent drug may also compromise pain management in this critical stage. Therefore, maintaining the same analgesic dosage is the most appropriate action to provide comfort and alleviate suffering.

5. The RN is making a home visit to a female client with end-stage heart disease. She has a living will and states she will never go back to the hospital. During the visit, the RN notes that the client is pale and SOB while speaking. The RN discovers 3+ edema in both ankles and bilateral pulmonary crackles. Which intervention should the RN implement first?

• A. Order a chest X-ray
• B. Obtain a peripheral O2 saturation reading
• C. Obtain an order for complete blood count
• D. Tell the patient to stay in bed

Correct answer: B

Rationale: Obtaining a peripheral O2 saturation reading is the priority intervention in this scenario. It helps assess the client's oxygenation status quickly, which is crucial in a client with signs of respiratory distress, such as shortness of breath and bilateral pulmonary crackles. Ordering a chest X-ray (Choice A) may be necessary later but does not address the immediate need for oxygen assessment. Obtaining an order for a complete blood count (Choice C) is not the priority in this situation as it does not directly address the client's respiratory distress. Instructing the patient to stay in bed (Choice D) does not address the underlying issue of potential hypoxia and respiratory compromise.

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