Nursing Elites

1. The nurse overhears two nursing students talking about a client in the cafeteria. What should the nurse do first?

• A. Report the incident to the nursing supervisor.
• B. Write up a variance report about the incident.
• C. Instruct the students that this is a violation of HIPAA.
• D. Notify the students' faculty regarding the violation.

Correct answer: C

Rationale: The correct answer is to instruct the students that discussing a client in a public area like the cafeteria violates HIPAA regulations. This is important to educate the students about patient confidentiality and the consequences of breaching it. Reporting to the nursing supervisor or faculty should come after addressing the students directly. Writing up a variance report is not the immediate action needed in this situation, as educating the students about their mistake should be the priority. It is essential to address the issue at the source by educating the students first rather than escalating the matter to supervisors or faculty immediately.

2. A child presents to the school nurse with left knee pain after suffering a fall on the playground. Which action should the nurse do first?

• A. Instruct the child to extend the affected knee
• B. Perform range of motion exercises on both knees
• C. Compare the appearance of the left knee to the right knee
• D. Have the child soak the affected knee in warm water

Correct answer: C

Rationale: Comparing the appearance of the left knee to the right knee is the most appropriate initial action as it provides a baseline for assessing any visible differences such as swelling, bruising, or deformities. This comparison helps the nurse identify any acute changes in the affected knee's appearance after the fall. Instructing the child to extend the affected knee (Choice A) may worsen the pain or cause further injury. Performing range of motion exercises on both knees (Choice B) could exacerbate the pain and should be avoided until a proper assessment is done. Having the child soak the affected knee in warm water (Choice D) is not the priority at this stage as assessing for any physical changes is more crucial.

3. What task should the RN perform first?

• A. Changing a burn dressing that is scheduled every four hours.
• B. Doing pinsite care on a client in skeletal traction ordered TID.
• C. Teaching a newly diagnosed diabetic about diet and exercise.
• D. Assessing a newly admitted client.

Correct answer: D

Rationale: The correct answer is to assess a newly admitted client first. When a client is newly admitted, it is crucial to perform an assessment promptly. The initial assessment and establishment of a care plan should be completed within a specific timeframe to ensure the client's needs are met effectively. Choices A, B, and C involve important tasks but should be prioritized after the initial assessment of the newly admitted client to ensure timely and appropriate care delivery. Changing a burn dressing (Choice A) and doing pinsite care on a client in skeletal traction (Choice B) are time-sensitive tasks but can be safely delayed briefly to conduct the initial assessment. Teaching a newly diagnosed diabetic about diet and exercise (Choice C) is important for the client's long-term care but can be scheduled after the immediate needs assessment of the newly admitted client.

4. Which of the following is an inappropriate item to include in planning care for a severely neutropenic client?

• A. Transfuse neutrophils (granulocytes) to prevent infection.
• B. Exclude raw vegetables from the diet.
• C. Avoid administering rectal suppositories.
• D. Prohibit vases of fresh flowers and plants in the client's room.

Correct answer: A

Rationale: Transfusing neutrophils (granulocytes) to prevent infection is inappropriate in the care of a severely neutropenic client. Neutrophils normally comprise 70% of all white blood cells and can be beneficial in a selected population of infected, severely granulocytopenic clients (less than 500/mm3) who do not respond to antibiotic therapy and who are expected to experience prolonged suppression of granulocyte production. Therefore, transfusing neutrophils is not a standard practice in caring for neutropenic clients. The other choices are appropriate in caring for a severely neutropenic client: excluding raw vegetables from the diet to reduce the risk of infections from potential pathogens, avoiding administering rectal suppositories to prevent any injury or infection due to mucosal damage, and prohibiting vases of fresh flowers and plants in the client's room to minimize the risk of exposure to environmental pathogens.

5. A 28-year-old male has a diagnosis of AIDS. The patient has had a two-year history of AIDS. The most likely cognitive deficits include which of the following?

• A. Disorientation
• B. Sensory changes
• C. Inability to produce sound
• D. Hearing deficits

Correct answer: A

Rationale: In individuals with AIDS, cognitive deficits commonly manifest as confusion and disorientation, making choice A, 'Disorientation,' the correct answer. Sensory changes (choice B) and hearing deficits (choice D) are more related to sensory processing rather than cognitive impairment. 'Inability to produce sound' (choice C) is more indicative of a speech or language deficit rather than a cognitive impairment typically seen in AIDS patients.

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