Nursing Elites

1. Which of these clients with associated lab reports is a priority for the nurse to report to the public health department within the next 24 hours?

• A. An infant with a positive stool culture for Shigella
• B. An elderly factory worker with a positive lab report for acid-fast bacillus smear
• C. A young adult commercial pilot with a positive histopathological examination for Pneumocystis carinii from an induced sputum
• D. A middle-aged nurse with a history of varicella-zoster virus and crops of vesicles on an erythematous base appearing on the skin

Correct answer: B

Rationale: The correct answer is B because a positive acid-fast bacillus smear in an elderly factory worker suggests tuberculosis, a serious communicable disease that must be reported promptly to the public health department to prevent its spread. Choice A is incorrect as Shigella is an important pathogen, but it does not require immediate public health reporting. Choice C is incorrect because Pneumocystis carinii is an opportunistic pathogen and does not require urgent public health reporting. Choice D is incorrect as varicella-zoster virus causes chickenpox and shingles, both of which are not reportable diseases to the public health department.

2. A client has altered renal function and is being treated at home. The nurse recognizes that the most accurate indicator of fluid balance during the weekly visits is:

• A. difference in the intake and output
• B. changes in the mucous membranes
• C. skin turgor
• D. weekly weight

Correct answer: D

Rationale: In a client with altered renal function, monitoring fluid balance is crucial. Weekly weight is the most accurate indicator of fluid balance during the visits as it reflects cumulative changes in the body's fluid status. Changes in intake and output (Choice A) can provide valuable information, but weekly weight is a more direct measure of overall fluid retention or loss. Changes in mucous membranes (Choice B) and skin turgor (Choice C) can be influenced by factors other than fluid balance, making them less reliable indicators in this context.

3. A nurse is reinforcing teaching with a client who has COPD. Which of the following instructions by the nurse is appropriate?

• A. Drink carbonated beverages.
• B. Decrease fiber intake.
• C. Use bronchodilators after meals.
• D. Increase protein intake.

Correct answer: D

Rationale: The correct answer is to instruct the client to increase protein intake. This is appropriate because increasing protein intake can help maintain muscle mass and strength in clients with COPD. Option A, 'Drink carbonated beverages,' is incorrect as carbonated beverages can exacerbate COPD symptoms. Option B, 'Decrease fiber intake,' is also incorrect as fiber is important for digestion and should not be decreased unless specifically advised by a healthcare provider. Option C, 'Use bronchodilators after meals,' is incorrect because bronchodilators are typically used before meals to help open the airways for better breathing, not after meals.

4. A nurse at a provider's office is reinforcing teaching with a client who is being treated with chemotherapy and is losing weight. Which of the following instructions should the nurse give to increase the client's caloric intake? (Select one that doesn't apply).

• A. Top yogurt with granola.
• B. Use honey on toast.
• C. Use milk instead of water in recipes.
• D. Increase fluids during meals.

Correct answer: D

Rationale: Increasing fluids during meals does not directly contribute to increasing caloric intake. Topping yogurt with granola, using honey on toast, and using milk instead of water in recipes are effective ways to boost caloric intake. While adequate fluid intake is important for hydration and overall health, it does not address the specific need to increase caloric intake in this scenario.

5. When assessing constipation in elders, which action should be the nurse's priority?

• A. Obtain a complete blood count
• B. Obtain a health and dietary history
• C. Refer to a provider for a physical examination
• D. Measure height and weight

Correct answer: B

Rationale: The correct answer is to obtain a health and dietary history when assessing constipation in elders. This action is crucial as it helps the nurse identify potential causes and contributing factors to constipation in elderly clients. Obtaining a complete blood count (choice A) may be necessary at some point, but it is not the priority in this situation. Referring to a provider for a physical examination (choice C) and measuring height and weight (choice D) are important but are not the priority actions when assessing constipation.

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