Nursing Elites

1. Which is a physical, integumentary risk among the elderly population?

• A. Skin tears
• B. Thickened skin
• C. Thinning toe nails
• D. Less nasal hair

Correct answer: A

Rationale: Skin tears are a physical integumentary risk among the elderly population. As individuals age, their skin becomes thinner and more fragile, making them susceptible to skin tears. Thickened skin, thinning toenails, and reduced nasal hair are common age-related changes but do not pose the same level of risk as skin tears. Thickened skin may provide some protection, thinning toenails are primarily a cosmetic concern, and reduced nasal hair does not typically lead to significant health risks.

2. An infant is brought to the clinic by his mother, who has noticed that he holds his head in an unusual position and always faces to one side. Which of the following is the most likely explanation?

• A. Torticollis, with shortening of the sternocleidomastoid muscle
• B. Craniosynostosis, with premature closure of the cranial sutures
• C. Plagiocephaly, with flattening of one side of the head
• D. Hydrocephalus, with increased head size

Correct answer: A

Rationale: The correct answer is torticollis, characterized by the shortening of the sternocleidomastoid muscle, limiting the range of motion of the neck and causing the chin to point to the opposing side. Craniosynostosis is the premature closure of cranial sutures, leading to an abnormal head shape but not necessarily affecting head position. Plagiocephaly is flattening of one side of the head due to external forces or positioning, not muscle shortening. Hydrocephalus presents with an increased head size due to the accumulation of cerebrospinal fluid, not with a fixed head position.

3. A patient born in 1955 had hepatitis A infection 1 year ago. According to Centers for Disease Control and Prevention (CDC) guidelines, which action should the nurse include in care when the patient is seen for a routine annual physical exam?

• A. Start the hepatitis B immunization series.
• B. Teach the patient about hepatitis A immune globulin.
• C. Ask whether the patient has been screened for hepatitis C.
• D. Test for anti-hepatitis-A virus immune globulin M (anti-HAV-IgM).

Correct answer: C

Rationale: The correct action for the nurse to include in care when the patient is seen for a routine annual physical exam, according to CDC guidelines, is to ask whether the patient has been screened for hepatitis C. CDC guidelines recommend screening patients born between 1945 and 1965 for hepatitis C due to the high prevalence of undiagnosed cases in this age group. Starting the hepatitis B immunization series is not necessary as the patient already had hepatitis A infection. Teaching the patient about hepatitis A immune globulin is not indicated in this scenario. Testing for anti-hepatitis-A virus immune globulin M (anti-HAV-IgM) is not needed as the patient has already had hepatitis A.

4. One of the complications of complete bed rest and immobility is which of the following?

• A. Plantar flexion
• B. Dorsiflexion
• C. Extension contractures
• D. Adduction contractures

Correct answer: A

Rationale: Plantar flexion, or foot drop, is a common complication of complete bed rest and immobility. This condition occurs due to the weakening of muscles that lift the foot, leading to the foot dragging or being unable to clear the ground during walking. Dorsiflexion refers to moving the foot upwards, which is not a typical complication of immobility. Extension contractures involve the inability to fully extend a joint, while adduction contractures refer to the inability to move a limb away from the body. These types of contractures can also occur with immobility, but they are not specifically associated with foot drop.

5. Which of the following clients have barriers to accessing healthcare?

• A. A 36-year-old client who must use a wheelchair for mobility
• B. A 44-year-old client who is visiting the United States on a visa from India
• C. An 81-year-old client who is unable to drive
• D. All of the above

Correct answer: D

Rationale: All of the provided clients have barriers to accessing healthcare. Clients with physical limitations, such as the 36-year-old client using a wheelchair, may face challenges in mobility and accessing healthcare facilities. The 44-year-old client from India visiting the United States on a visa may encounter barriers related to language, cultural differences, or insurance coverage. The 81-year-old client who is unable to drive may struggle with transportation to healthcare appointments. Therefore, all three clients face different barriers to accessing healthcare, making 'All of the above' the correct answer.

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