Nursing Elites

1. What is an important nursing responsibility when a dysrhythmia is suspected?

• A. order an immediate electrocardiogram
• B. count the radial pulse every 1 minute for five times
• C. count the apical pulse for 1 full minute, and compare the rate with the radial pulse rate
• D. have someone else take the radial pulse simultaneously with the apical pulse

Correct answer: C

Rationale: When a dysrhythmia is suspected, an important nursing responsibility is to count the apical pulse for 1 full minute and then compare this rate with the radial pulse rate. This method helps in identifying dysrhythmias as it allows for a direct comparison of the heart's rhythm at two different pulse points. Ordering an immediate electrocardiogram (Choice A) may be necessary but should not be the first step. Counting the radial pulse multiple times (Choice B) is not as accurate as comparing rates directly. Having someone else take the radial pulse simultaneously (Choice D) may introduce errors and inconsistencies in the measurement.

2. Which of the following findings would indicate altered mental status in a small child?

• A. Recognition of the parents
• B. Fright at the EMT-B's presence
• C. Lack of attention to the EMT-B's presence
• D. Consistent eye contact with the EMT-B

Correct answer: C

Rationale: In small children, altered mental status can manifest as a lack of attention to the presence of unfamiliar individuals, such as the EMT-B. This lack of engagement may indicate confusion, disorientation, or impaired cognitive function. Choices A, B, and D are incorrect as recognizing parents, exhibiting fear, or maintaining consistent eye contact do not necessarily indicate altered mental status. Recognizing parents is a normal response, fear can be a typical reaction to unfamiliar situations, and making eye contact may be a sign of curiosity or comfort rather than a reflection of mental status.

3. The parent of a child who has received all of the primary immunizations asks the nurse which ones the child should receive before starting kindergarten. The nurse tells the parent that her child should receive boosters of:

• A. IPV, HepB, Td.
• B. DTaP, HepB, Td.
• C. MMR, DTaP, Hib.
• D. DTaP, IPV, MMR.

Correct answer: D

Rationale: The correct answer is D: DTaP, IPV, MMR. Before starting kindergarten, the child should receive boosters of DTaP, IPV, and MMR to ensure ongoing protection against diphtheria, tetanus, pertussis, polio, measles, mumps, and rubella. Choice A is incorrect because it includes HepB instead of MMR. Choice B is incorrect as it includes HepB instead of MMR and DTaP instead of IPV. Choice C is incorrect as it includes Hib instead of IPV.

4. Surgical repair for patent ductus arteriosus (PDA) is done to prevent the complication of

• A. pulmonary infection
• B. right-to-left shunt of blood
• C. decreased workload on left side of the heart
• D. increased pulmonary vascular congestion

Correct answer: D

Rationale: The correct answer is D: increased pulmonary vascular congestion. Surgical repair of patent ductus arteriosus (PDA) aims to prevent the complications associated with increased pulmonary vascular congestion, such as pulmonary hypertension and heart failure. Choice A, pulmonary infection, is not a direct complication of PDA but can occur secondary to other conditions. Choice B, right-to-left shunt of blood, is a feature of some congenital heart defects but not a direct complication of PDA. Choice C, decreased workload on the left side of the heart, is not a primary reason for surgical repair of PDA, as the main concern is the impact on pulmonary circulation.

5. When you attempt to assess a 22-year-old woman who has been sexually assaulted, and she orders you not to touch her, your most appropriate initial action should be to

• A. ask the patient to sign a release form
• B. ask a female EMT-B to attempt to assess the patient
• C. explain to the patient that she must be examined
• D. transport the patient without performing an assessment

Correct answer: B

Rationale: In this scenario, the patient has requested not to be touched, indicating a need for sensitivity and understanding. Asking a female EMT-B to attempt to assess the patient is the most appropriate initial action as it respects the patient's need for privacy, comfort, and potentially reduces re-traumatization. Asking the patient to sign a release form (Choice A) is not suitable as it disregards the patient's immediate concerns. Explaining to the patient that she must be examined (Choice C) may further distress her and violate her autonomy. Transporting the patient without performing an assessment (Choice D) ignores the patient's expressed wishes and may lead to inadequate care.

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