Nursing Elites

1. The parents of a 6-year-old child recently diagnosed with Duchenne muscular dystrophy tell the nurse that their child wants to continue attending swimming classes. How should the nurse respond?

• A. Encourage the parents to allow the child to continue attending swimming lessons with supervision
• B. Suggest that the child be encouraged to participate in a team sport to promote socialization
• C. Explain that their child is not mature enough to understand the risks associated with swimming
• D. Provide a list of alternative activities that are less likely to cause the child to experience fatigue

Correct answer: A

Rationale: Encouraging the parents to allow the child to continue attending swimming lessons with supervision is the most appropriate response. Swimming can be beneficial for the child, providing both exercise and enjoyment. Supervision can help manage any risks associated with swimming. Choice B is incorrect because the child's preference for swimming should be respected, and swimming can still offer socialization opportunities. Choice C is incorrect as it undermines the child's capability to understand the situation. Choice D is less appropriate as it does not address the child's interest in swimming and may limit beneficial physical activity.

2. Which client is at the greatest risk for developing delirium?

• A. An adult client who cannot sleep due to constant pain
• B. An older client who attempted suicide 1 month ago
• C. A young adult who takes antipsychotic medications twice a day
• D. A middle-aged woman who uses a tank for supplemental oxygen

Correct answer: B

Rationale: The correct answer is B because older adults are at higher risk for delirium, especially following a recent suicide attempt, which can be a significant stressor. Choice A is less likely to develop delirium solely due to difficulty sleeping; delirium is more complex and multifactorial. Choice C, a young adult taking antipsychotic medications, may be at risk for other conditions but not necessarily delirium. Choice D, a middle-aged woman using supplemental oxygen, is not directly linked to an increased risk of delirium compared to the older client who recently attempted suicide.

3. The nurse plans to collect a 24-hour urine specimen for a creatinine clearance test. Which instruction should the nurse provide to the adult male client?

• A. Urinate at the specified time, discard this urine, and collect all subsequent urine over the next 24 hours.
• B. Cleanse around the meatus, discard the first portion of voiding, and collect the rest in a sterile bottle.
• C. For the next 24 hours, notify the nurse when the bladder is full, and the nurse will collect catheterized specimens.
• D. Urinate immediately into a urinal, and the lab will collect the specimen every 6 hours for the next 24 hours.

Correct answer: A

Rationale: The correct instruction for the adult male client to follow when collecting a 24-hour urine specimen for a creatinine clearance test is to urinate at the specified time, discard this urine, and collect all subsequent urine over the next 24 hours. This method ensures proper collection for an accurate creatinine clearance measurement. Choice B is incorrect as it describes a different procedure for a clean-catch urine sample, not suitable for creatinine clearance. Choice C is incorrect as it suggests catheterization, which is not typically done for a creatinine clearance test, and it is not necessary for this procedure. Choice D is incorrect as it does not follow the standard procedure for a 24-hour urine collection for creatinine clearance; the urine should be collected continuously over 24 hours, not at specified intervals.

4. In developing a plan of care for a client admitted to a mental health unit after attempting suicide by taking a handful of medications, which goal has the highest priority?

• A. Signs a no-self-harm contract
• B. Sleep for at least 6 hours nightly
• C. Attends group therapy every day
• D. Verbalizes a positive self-image

Correct answer: A

Rationale: The correct answer is A: Signs a no-self-harm contract. Ensuring the client’s immediate safety by having them commit to not engaging in self-harm is the highest priority after a suicide attempt. This measure aims to prevent further harm to the client. While sleep, group therapy, and self-image are important aspects of care, they are secondary to ensuring the client's safety in the immediate aftermath of a suicide attempt. Prioritizing the establishment of a no-self-harm contract creates a foundation for addressing other therapeutic goals in the client's care plan.

5. When educating a group of school-age children on reducing the risk of Lyme disease, which instruction should the camp nurse include?

• A. Wash hands frequently
• B. Avoid drinking lake water
• C. Wear long sleeves and pants
• D. Do not share personal products

Correct answer: C

Rationale: The correct instruction to reduce the risk of Lyme disease is to wear long sleeves and pants. This helps prevent tick bites, which are the primary mode of transmission for Lyme disease. Wearing protective clothing reduces the skin's exposure to ticks, decreasing the chances of getting bitten. Washing hands frequently (Choice A) is important for general hygiene but not specifically for preventing Lyme disease. Avoiding drinking lake water (Choice B) is unrelated to the prevention of Lyme disease. Not sharing personal products (Choice D) is important for preventing the spread of infections but does not directly reduce the risk of Lyme disease.

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