Nursing Elites

1. Which of the following neurological disorders is characterized by writhing, twisting movements of the face and limbs?

• A. epilepsy
• B. Parkinson's
• C. multiple sclerosis
• D. Huntington's chorea

Correct answer: D

Rationale: Huntington's chorea is characterized by writhing, twisting movements of the face and limbs, known as chorea. This disorder is caused by a genetic mutation affecting specific brain cells. Epilepsy presents with seizures, Parkinson's with tremors and rigidity, and multiple sclerosis with central nervous system issues. The specific description of writhing and twisting movements aligns with Huntington's chorea, making it the correct answer. Choices A, B, and C are incorrect as they describe different neurological disorders with distinct symptoms that do not match the writhing, twisting movements characteristic of Huntington's chorea.

2. The ICU nurse caring for a client who has just been declared brain dead can expect to find evidence of the client's wishes regarding organ donation:

• A. on the client's driver's license.
• B. in the client's safety deposit box.
• C. in the client's last will and testament.
• D. on the client's insurance card.

Correct answer: A

Rationale: In most states, indication of organ donor status is found on the client's driver's license, making it easily accessible for decision-making in critical situations like declaring brain death. Evidence in a last will and testament or a safety deposit box may not be promptly available. Information about organ donation is typically not included on insurance cards. The primary care physician's health record documentation could also be a relevant source for the ICU nurse. Therefore, the correct answer is finding evidence of the client's wishes regarding organ donation on the client's driver's license.

3. When observing a dressing change by a graduate nurse on a Stage III pressure ulcer to the greater trochanter by the staff nurse, a need for further teaching is indicated after the following observation by the nurse:

• A. The new graduate nurse irrigates the pressure ulcer with 50cc of NS.
• B. The new graduate irrigates the pressure ulcer with half-strength hydrogen peroxide.
• C. The new graduate packs the wound with sterile kerlix soaked in NS.
• D. The new graduate applies a Duoderm dressing over the wound after cleansing.

Correct answer: B

Rationale: The correct answer is that the new graduate irrigates the pressure ulcer with half-strength hydrogen peroxide. Pressure ulcers should not be cleaned with substances that are cytotoxic, such as hydrogen peroxide or betadine. This can cause further damage to the wound and delay the healing process. Choice A is incorrect because irrigating the pressure ulcer with normal saline is an appropriate practice. Choice C is incorrect because packing the wound with sterile kerlix soaked in normal saline is also an appropriate step. Choice D is incorrect because applying a Duoderm dressing after cleansing is a standard procedure in wound care.

4. When administering NSAID adjunctive therapy to an elderly client with cancer, the nurse must monitor:

• A. BUN and creatinine.
• B. creatinine and calcium.
• C. Hgb and Hct.
• D. BUN and CFT.

Correct answer: A

Rationale: When an elderly client with cancer is receiving NSAID therapy, monitoring BUN (blood urea nitrogen) and creatinine levels is crucial. NSAIDs can cause renal toxicity, especially in the elderly. BUN and creatinine levels help assess renal function and detect early signs of renal impairment. Monitoring creatinine alone (Choice B) is not sufficient as BUN provides complementary information about renal function. Monitoring hemoglobin (Hgb) and hematocrit (Hct) (Choice C) is important for assessing anemia but not specific to NSAID therapy in the elderly. CFT (Choice D) is not a standard abbreviation in this context, and monitoring coagulation function is not directly related to NSAID therapy in this scenario.

5. A case management clinical pathway for congestive heart failure might include all of the following except:

• A. physician follow-up appointments with transportation
• B. client education regarding medication use
• C. a nutritional consult for diet review and accommodation
• D. insurance review for reimbursement

Correct answer: D

Rationale: In a case management clinical pathway for congestive heart failure, the focus is on providing medical care and support to the patient. Choices A, B, and C are integral parts of managing congestive heart failure. Physician follow-up appointments with transportation ensure continuity of care, client education about medication use is crucial for adherence, and a nutritional consult helps in managing the patient's diet. However, insurance review for reimbursement is not typically part of the clinical pathway as it pertains to financial aspects and is usually handled by billing departments or external agencies. Therefore, the correct answer is 'insurance review for reimbursement.'

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