Nursing Elites

1. What is the primary route of transmission of MRSA?

• A. Shared needles
• B. Hands of healthcare workers
• C. Items in the healthcare environment
• D. Blood transfusions

Correct answer: B

Rationale: The correct answer is 'Hands of healthcare workers.' MRSA is primarily transmitted via the unwashed hands of healthcare workers who can carry the Staphylococcus aureus bacterium from one patient to another. Shared needles, items in the healthcare environment, and blood transfusions are not the main routes of transmission for MRSA. Shared needles can transmit bloodborne pathogens, items in the healthcare environment can harbor bacteria but are not the primary mode for MRSA, and blood transfusions are not a common route for MRSA transmission.

2. Penny Thornton has had a stroke, or CVA, and is having difficulty eating on her own. Soon, she will be getting some assistive devices for eating meals. Which healthcare worker will be providing Penny with these assistive devices?

• A. A physical therapist
• B. A speech therapist
• C. A social worker
• D. An occupational therapist

Correct answer: D

Rationale: An occupational therapist is the healthcare professional responsible for assessing the needs of individuals, like Penny, regarding assistive devices that aid them in their daily activities. In this case, assistive devices for eating, such as weighted plates and specialized utensils, are crucial for helping Penny regain independence in feeding herself. Physical therapists focus more on mobility and movement, speech therapists on communication and swallowing disorders, and social workers on providing emotional and social support. Therefore, the correct choice is the occupational therapist as they specialize in activities of daily living and promoting independence.

3. The categories such as ethnicity, gender, and religion illustrate which concept?

• A. Family
• B. Cultures
• C. Spirituality
• D. Subcultures

Correct answer: D

Rationale: Within cultures, various groups of people share different beliefs, values, and attitudes due to factors such as ethnicity, religion, education, occupation, age, and gender. When these distinct groups coexist within a broader culture, they are referred to as subcultures. While ethnicity, gender, and religion are important components of individuals' identities, they do not represent the concepts of family, cultures, or spirituality. The correct answer is 'Subcultures' as these categories reflect differences within a larger cultural context, emphasizing the unique characteristics shared by members of subcultural groups.

4. During an assessment, the nurse notices that a patient is handling a small charm that is tied to a leather strip around their neck. Which action by the nurse is appropriate?

• A. Ask the patient about the item and its significance.
• B. Ask the patient to lock the item with other valuables in the hospital's safe.
• C. Tell the patient that a family member should take valuables home.
• D. No action is necessary.

Correct answer: A

Rationale: The small charm tied to a leather strip is likely an amulet, which many cultures consider an important means of protection from 'evil spirits.' When a patient appears to have a health practice the nurse is unfamiliar with, the nurse should ask for clarification in a non-judgmental way that communicates acceptance of their beliefs and allows for open communication. Thus, the nurse in this situation should inquire about the amulet's meaning to the patient. Asking the patient to lock the item with other valuables in the hospital's safe, telling the patient that a family member should take valuables home, or doing nothing does not address the importance or meaning of a cultural health practice to the patient and does not allow the nurse to gain an understanding of the patient's cultural health practices.

5. The nurse is taking an initial blood pressure reading on a 72-year-old patient with documented hypertension. How should the nurse proceed?

• A. Cuff should be placed on the patient's arm and inflated 30 mm Hg above the point at which the palpated pulse disappears.
• B. Cuff should be inflated to 200 mm Hg in an attempt to obtain the most accurate systolic reading.
• C. Cuff should be inflated 30 mm Hg above the patient's pulse rate.
• D. After confirming the patient's previous blood pressure readings, the cuff should be inflated 30 mm Hg above the highest systolic reading recorded.

Correct answer: C

Rationale: When measuring blood pressure, it's important to account for the possibility of an auscultatory gap, which occurs in about 5% of individuals, particularly those with hypertension due to a noncompliant arterial system. To detect an auscultatory gap, the cuff should be inflated 20 to 30 mm Hg beyond the point at which the palpated pulse disappears. This ensures an accurate measurement of blood pressure by overcoming the potential gap in sounds. Choice A is correct as it follows this guideline. Choices B and C are incorrect because inflating the cuff to 200 mm Hg or above the patient's pulse rate does not address the specific issue of an auscultatory gap. Choice D is incorrect as it focuses on the patient's previous readings rather than the current measurement technique needed to detect an auscultatory gap.

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