Nursing Elites

1. When is cleft palate repair usually performed in children?

• A. A cleft palate cannot be repaired in children.
• B. Repair is usually performed by age 8 weeks.
• C. Repair is usually performed by 2 months of age.
• D. Repair is usually performed between 6 months and 2 years.

Correct answer: D

Rationale: Cleft palate repair timing is individualized based on the severity of the deformity and the child's size. Typically, cleft palate repair is performed between 6 months and 2 years of age. This age range allows for optimal outcomes and is often done before 12 months to promote normal speech development. Early closure of the cleft palate helps to facilitate speech development. Options A, B, and C are incorrect because a cleft palate can be repaired in children, and repair is usually performed between 6 months and 2 years of age, not at 8 weeks or 2 months.

2. After assessing Mr. B, what is the initial action of the nurse?

• A. Immediately place the client in a negative-pressure room
• B. Set the client up to receive a bronchoscopy
• C. Contact the physician for antifungal medications
• D. Administer oxygen and assist the client to sit in the semi-Fowler's position

Correct answer: A

Rationale: The first action the nurse should take after assessing Mr. B is to administer oxygen and assist him to sit in the semi-Fowler's position. Administering oxygen helps improve tissue oxygenation, while sitting up in a semi-Fowler's position aids in better breathing and secretion clearance. Placing the client in a negative-pressure room is not the immediate priority unless isolation is needed. Performing a bronchoscopy or contacting the physician for antifungal medications is not the initial step in managing a client with suspected pneumonia.

3. The nurse provides preoperative instruction for a patient scheduled for a left pneumonectomy for lung cancer. Which information should the nurse include about the patient's postoperative care?

• A. Positioning on the right side
• B. Bed rest for the first 24 hours
• C. Frequent use of an incentive spirometer
• D. Chest tube placement with continuous drainage

Correct answer: C

Rationale: After a pneumonectomy, frequent deep breathing and coughing are essential to prevent atelectasis and promote gas exchange. Patients are typically positioned on the surgical side to aid in gas exchange. Early mobilization is crucial to reduce the risk of postoperative complications such as pneumonia and deep vein thrombosis. While chest tubes may or may not be placed in the surgical space, if used, they are clamped and only adjusted by the surgeon to manage serosanguineous fluid accumulation. Overfilling of the chest cavity can compromise remaining lung function and cardiovascular status. Chest x-rays are useful for monitoring fluid volume and space postoperatively. Therefore, the correct postoperative care instruction for the patient undergoing a left pneumonectomy is the frequent use of an incentive spirometer. Choices A, B, and D are incorrect as positioning on the right side, bed rest for the first 24 hours, and continuous chest tube drainage are not standard postoperative care practices for patients undergoing pneumonectomy.

4. A client comes to the clinic for treatment of recurrent pelvic inflammatory disease. The nurse recognizes that this condition most frequently follows which type of infection?

• A. Trichomoniasis
• B. Chlamydia
• C. Staphylococcus
• D. Streptococcus

Correct answer: B

Rationale: Chlamydial infections are one of the most common causes of salpingitis or pelvic inflammatory disease. Chlamydia can ascend from the vagina or cervix to the reproductive organs, leading to inflammation and infection. Trichomoniasis, caused by a parasite, typically presents with different symptoms than pelvic inflammatory disease and is not the primary cause. Staphylococcus and Streptococcus are bacteria that can cause other types of infections but are not the primary culprits in most cases of pelvic inflammatory disease.

5. The nurse plans health care for a community with a large number of recent immigrants from Vietnam. Which intervention is the most important for the nurse to implement?

• A. Hepatitis testing
• B. Tuberculosis screening
• C. Contraceptive teaching
• D. Colonoscopy information

Correct answer: B

Rationale: Tuberculosis (TB) is prevalent in many parts of Asia, including Vietnam, and the incidence of TB is higher in immigrants from Vietnam compared to the general U.S. population. Conducting tuberculosis screening is crucial to identify and address any cases promptly, especially in a community with recent immigrants from Vietnam. While teaching about contraceptive use, providing colonoscopy information, and testing for hepatitis may be relevant for certain individuals in the community, they are not as universally important as tuberculosis screening due to the increased risk of TB among Vietnamese immigrants.

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