Nursing Elites

1. Which of the following measures would be appropriate for a nurse to teach the parent of a nine-month-old infant about diaper dermatitis?

• A. Use only cloth diapers that are rinsed in bleach
• B. Do not use occlusive ointments on the rash
• C. Use commercial baby wipes with each diaper change
• D. Discontinue a new food that was added to the infant's diet just prior to the rash

Correct answer: D

Rationale: Diaper dermatitis can be caused by various factors, one of which includes introducing new foods to the infant's diet. Discontinuing the new food that was added just before the rash can help identify and eliminate the potential cause. Options A and C are not directly related to addressing the cause of diaper dermatitis. While using cloth diapers rinsed in bleach may be a preventive measure for diaper dermatitis, it is not addressing a specific cause. Option B, advising against using occlusive ointments on the rash, may actually be beneficial in managing diaper dermatitis, but it does not address the cause of the condition.

2. A patient's nursing diagnosis is Insomnia. The desired outcome is: "Patient will sleep for a minimum of 5 hours nightly by October 31."? On November 1, a review of the sleep data shows the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. What is the nurse's next action?

• A. Continue the current plan without changes.
• B. Remove this nursing diagnosis from the plan of care.
• C. Write a new nursing diagnosis that better reflects the problem.
• D. Revise the target date for outcome attainment and examine interventions.

Correct answer: D

Rationale: The correct action for the nurse in this scenario is to revise the target date for outcome attainment and reevaluate interventions. The initial desired outcome was for the patient to sleep for a minimum of 5 hours nightly by October 31. Since the patient is currently sleeping an average of 4 hours nightly and taking a 2-hour afternoon nap, the goal has not been achieved. By extending the time frame for attaining the outcome, the patient may have more time to progress towards the desired sleep duration. Additionally, examining interventions is crucial to identify any changes or adjustments that may be necessary to help the patient achieve the desired outcome. Continuing the current plan without changes is not appropriate as the goal has not been met. Removing the nursing diagnosis from the plan of care should only be considered when the problem is resolved. Writing a new nursing diagnosis is not needed as the current diagnosis of Insomnia still accurately reflects the patient's condition.

3. Which of the following factors may alter the level of consciousness in a patient?

• A. Alcohol
• B. Electrolytes
• C. Infection
• D. All of the above may cause altered level of consciousness

Correct answer: D

Rationale: Various factors can lead to altered levels of consciousness in a patient. Alcohol consumption can depress the central nervous system and cause changes in consciousness. Electrolyte imbalances, such as hyponatremia or hypernatremia, can disrupt brain function and affect consciousness. Infections, especially those affecting the brain like encephalitis, can also lead to alterations in consciousness. Therefore, all of the choices provided - Alcohol, Electrolytes, and Infection - can potentially cause changes in the level of consciousness. Remember the acronym AEIOU-TIPPS to recall common causes of decreased level of consciousness, including Alcohol, Electrolytes, and Infection, among others.

4. What is the likely cause of pericarditis in a young patient?

• A. Heart failure
• B. Acute MI
• C. Hypertension
• D. Infectious processes

Correct answer: D

Rationale: In younger patients, pericarditis is typically caused by an infection commonly triggered by viruses like the Coxsackie virus, streptococcus, staphylococcus, or Haemophilus influenzae. Infectious processes are the leading cause of pericarditis in younger individuals. Heart failure, Acute MI, and Hypertension are not common causes of pericarditis in young patients. In older adults, acute myocardial infarction (MI) is a more common cause of pericarditis.

5. A nurse is caring for a patient after a coronary angiogram. Which of these actions taken by the nursing assistant would most require the nurse's immediate intervention?

• A. The nursing assistant fills the patient's pitcher with ice-cold drinking water
• B. The nursing assistant elevates the head of the bed to 60 degrees for a meal
• C. The nursing assistant refills the ice pack placed on the insertion site
• D. The nursing assistant places an extra pillow under the patient's head upon request

Correct answer: B

Rationale: After a coronary angiogram, patients need to maintain bed rest and keep the head of the bed at no more than 30 degrees for 3-6 hours, depending on the insertion site. Elevating the head of the bed to 60 degrees for a meal could increase the risk of bleeding or complications at the insertion site. Refilling the ice pack placed on the insertion site is appropriate for managing potential swelling or discomfort. Filling the patient's pitcher with ice-cold drinking water is a standard care task. Placing an extra pillow under the patient's head upon request is a comfort measure and does not pose a risk to the patient's recovery.

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