Nursing Elites

1. What should a healthcare professional do when a client with anorexia nervosa insists on working out constantly?

• A. Allow the client to workout and continue their regimen
• B. Restrict the client's workout regimen to one hour a day
• C. Discuss the risks of over-exercising with the client
• D. Speak to the client privately to uncover the source of the obsession

Correct answer: D

Rationale: When dealing with a client with anorexia nervosa who insists on working out constantly, it is crucial to address the situation sensitively. Speaking to the client privately to uncover the source of the obsession is the most appropriate action. This approach allows the healthcare professional to understand the underlying reasons for the behavior and work towards a solution together. Choices A and B could potentially exacerbate the client's condition by either enabling the behavior or imposing restrictions without addressing the root cause. While choice C is important, simply discussing the risks may not address the client's compulsion to exercise excessively.

2. Which of the following is an early indicator that a client with a tracheostomy may require suctioning?

• A. Decreased respiratory rate
• B. Irritability
• C. Bradycardia
• D. Decreased oxygen saturation

Correct answer: B

Rationale: Irritability is an early indicator that suctioning is necessary for a client with a tracheostomy. Irritability can signal discomfort or difficulty breathing, which may be due to the need for suctioning to clear the airway. Decreased respiratory rate, bradycardia, and decreased oxygen saturation are not typically early indicators that suctioning is needed in a client with a tracheostomy. These symptoms may occur later if the airway is not cleared promptly.

3. What are the key nursing interventions for a patient with a tracheostomy?

• A. Maintain a patent airway and monitor for infection
• B. Suction airway secretions and provide humidified oxygen
• C. Educate patient on self-care and tracheostomy cleaning
• D. Change tracheostomy ties daily

Correct answer: A

Rationale: The correct answer is to maintain a patent airway and monitor for infection. These are crucial nursing interventions for patients with tracheostomies to ensure adequate oxygenation and prevent complications. Suctioning airway secretions and providing humidified oxygen can be part of the care plan but are not as essential as maintaining a patent airway. Educating the patient on self-care and tracheostomy cleaning is important for long-term management but is not as immediate as ensuring a patent airway and monitoring for infection. Changing tracheostomy ties daily is a specific task related to tracheostomy care but is not as critical as ensuring the airway is clear and infection-free.

4. A nurse is caring for a client who has a terminal illness and is approaching death. Which of the following findings should the nurse identify as an indication of impending death?

• A. Hypertension.
• B. Tachycardia.
• C. Cold extremities.
• D. Diaphoresis.

Correct answer: C

Rationale: Cold extremities are a critical sign of impending death as they indicate decreased circulation, leading to poor perfusion to the extremities. This phenomenon occurs as the body redirects blood flow to vital organs, preparing for the end of life. Hypertension and tachycardia are less likely to be seen in the terminal phase and are usually associated with other conditions like shock or sepsis. Diaphoresis, or excessive sweating, may occur in various situations but is not a specific indicator of impending death in this context.

5. A nurse is caring for a client who is experiencing post-traumatic stress disorder (PTSD). Which of the following manifestations should the nurse expect?

• A. Hyperactivity
• B. Hypervigilance
• C. Restlessness
• D. Avoidance of social situations

Correct answer: B

Rationale: The correct answer is B: Hypervigilance. Individuals with PTSD often experience hypervigilance, which involves being overly alert, easily startled, and constantly scanning their environment for potential threats. This heightened state of awareness is a common response to the trauma experienced. Choices A, C, and D are incorrect. Hyperactivity is not typically a primary manifestation of PTSD; restlessness may occur but is not as characteristic as hypervigilance, and although avoidance of social situations can be a symptom of PTSD, hypervigilance is more directly associated with the disorder.

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