Nursing Elites

1. The school nurse is called to the playground for an episode of mouth trauma. The nurse finds that the front tooth of a 9-year-old child has been avulsed (knocked out). After recovering the tooth, the initial response should be to

• A. Rinse the tooth in water before placing it in the socket
• B. Place the tooth in a clean plastic bag for transport to the dentist
• C. Hold the tooth by the roots until reaching the emergency room
• D. Ask the child to replace the tooth even if the bleeding continues

Correct answer: A

Rationale: The correct immediate action after recovering an avulsed tooth is to rinse it with water and place it back in the socket. This helps preserve the tooth and increases the chances of successful re-implantation. Placing the tooth in a clean plastic bag for transport to the dentist (choice B) is not ideal as immediate re-implantation is preferred. Holding the tooth by the roots until reaching the emergency room (choice C) can further damage the tooth. Asking the child to replace the tooth even if bleeding continues (choice D) is incorrect and may lead to improper re-implantation.

2. Which of the following patients should the home care nurse assess first?

• A. A 65-year-old male with known COPD and difficulty breathing after climbing a flight of stairs.
• B. A 78-year-old with CHF who has gained 4 lbs according to her tele-monitoring.
• C. A 50-year-old with bilateral leg swelling and difficulty walking.
• D. A 60-year-old with lower back pain.

Correct answer: A

Rationale: The correct answer is A. A patient with known COPD and difficulty breathing after physical exertion like climbing stairs requires immediate assessment by the nurse. This could indicate a potential exacerbation of COPD, which needs prompt intervention to prevent respiratory distress. Choices B, C, and D describe important patient situations that also require attention, but the urgency is higher with a COPD patient experiencing difficulty breathing.

3. The RN is serving on a medical center committee to update goals and protocols based on the national standards. Which goal most directly addresses the Healthy People 2020 initiative?

• A. Reduce ED wait time for indigent clients
• B. Providing transportation for medically challenged clients
• C. Provide access to health services
• D. Refer clients to local health department for medical services

Correct answer: C

Rationale: The correct answer is C: 'Provide access to health services.' This goal most directly addresses the Healthy People 2020 initiative, which aims to improve health care access for all individuals. Option A, 'Reduce ED wait time for indigent clients,' focuses on efficiency rather than access. Option B, 'Providing transportation for medically challenged clients,' addresses a specific need but does not cover overall health service access. Option D, 'Refer clients to local health department for medical services,' involves referral rather than direct access to services.

4. What title should be given to this occupational health nurse job description? A registered nurse with expertise in health promotion, illness and injury prevention, risk reduction, and adult learning principles.

• A. case manager
• B. health educator
• C. nurse consultant
• D. health promotion specialist

Correct answer: D

Rationale: The correct answer is 'D: health promotion specialist.' This title aligns with the described expertise in health promotion, illness and injury prevention, and risk reduction. A health promotion specialist focuses on promoting health and preventing illnesses, which directly corresponds to the skills mentioned in the job description. Choices A, B, and C are incorrect. A 'case manager' typically focuses on coordinating patient care, 'health educator' specifically emphasizes educating individuals on health topics, and a 'nurse consultant' offers expert advice and support in the nursing field but may not specialize in health promotion and risk reduction as required in this job description.

5. When the nurse identifies what appears to be ventricular tachycardia on the cardiac monitor of a client being evaluated for possible myocardial infarction, the first action the nurse should perform is to

• A. Begin cardiopulmonary resuscitation
• B. Prepare for immediate defibrillation
• C. Notify the 'Code' team and healthcare provider
• D. Assess airway, breathing, and circulation

Correct answer: D

Rationale: The correct first action for the nurse to take when identifying what appears to be ventricular tachycardia in a client being evaluated for possible myocardial infarction is to assess the client's airway, breathing, and circulation. This step is crucial to determine the client's stability and the need for immediate intervention. Beginning cardiopulmonary resuscitation or preparing for immediate defibrillation without first assessing the airway, breathing, and circulation could delay potentially life-saving interventions. Notifying the 'Code' team and healthcare provider should come after ensuring the client's immediate needs are addressed.

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