Nursing Elites

1. While caring for a client with infective endocarditis, the nurse must be alert for signs of pulmonary embolism. Which of the following assessment findings suggests this complication?

• A. Positive Homan's sign
• B. Fever and chills
• C. Dyspnea and cough
• D. Sensory impairment

Correct answer: C

Rationale: The correct answer is C: 'Dyspnea and cough.' Pulmonary embolism often presents with a sudden onset of dyspnea (difficulty breathing) and cough, which are due to the obstruction of blood flow in the pulmonary arteries. Choices A, B, and D are incorrect. Positive Homan's sign is associated with deep vein thrombosis, fever and chills are nonspecific symptoms commonly seen in infective endocarditis, and sensory impairment is not typically indicative of pulmonary embolism.

2. Which of the following strategies is most effective in promoting breastfeeding in a community?

• A. Providing formula samples
• B. Offering breastfeeding education and support
• C. Encouraging early weaning
• D. Promoting bottle feeding

Correct answer: B

Rationale: The most effective strategy in promoting breastfeeding in a community is offering breastfeeding education and support. This helps mothers learn about the benefits of breastfeeding, gain confidence in their ability to breastfeed, and receive necessary support to overcome challenges. Providing formula samples (Choice A) can undermine breastfeeding efforts by promoting formula feeding over breastfeeding. Encouraging early weaning (Choice C) goes against the recommendation of exclusive breastfeeding for the first six months of life. Promoting bottle feeding (Choice D) can deter mothers from initiating or continuing breastfeeding, leading to decreased breastfeeding rates.

3. Which of the following is an example of a positive outcome for one of the Leading Health Indicators of Healthy People 2020?

• A. A community has adopted a no smoking policy.
• B. A rural community has a public transportation system.
• C. The high school dropout rate has decreased by 15%.
• D. A county has decreased its divorce rate by 10%.

Correct answer: A

Rationale: The correct answer is A. A community adopting a no smoking policy is a positive outcome for the Leading Health Indicators of Healthy People 2020 as it promotes a healthier environment by reducing exposure to secondhand smoke and decreasing smoking-related illnesses. Choices B, C, and D do not directly align with the goals of the Leading Health Indicators. While public transportation and reduced dropout rates are beneficial for community well-being, they are not specific examples of Leading Health Indicators. Decreasing divorce rates, while potentially beneficial for family stability, is not a focus area of the Leading Health Indicators.

4. The healthcare provider is evaluating the health status of a 16-year-old client with a history of Type 1 diabetes. Which laboratory test would provide the most accurate information about long-term blood glucose control?

• A. Blood glucose level
• B. Glycosylated hemoglobin
• C. Urine ketones
• D. Serum insulin level

Correct answer: B

Rationale: The correct answer is B: Glycosylated hemoglobin (HbA1c). Glycosylated hemoglobin provides valuable information about blood glucose control over the past 2-3 months. This test measures the average blood sugar levels during this period, offering a more comprehensive view of long-term glycemic control. Choice A, blood glucose level, reflects the blood sugar concentration at the time of testing and may fluctuate throughout the day. Choice C, urine ketones, indicates the presence of ketones and is more relevant for assessing acute complications like diabetic ketoacidosis. Choice D, serum insulin level, evaluates insulin production and is not a direct indicator of long-term blood glucose control in diabetes management.

5. A client with a peptic ulcer is scheduled for a vagotomy and pyloroplasty. The nurse explains that the purpose of this surgery is to:

• A. Increase acid secretion
• B. Reduce acid secretion
• C. Promote gastric emptying
• D. Remove the ulcerated area

Correct answer: B

Rationale: The correct answer is B: "Reduce acid secretion." Vagotomy is performed to reduce acid secretion by cutting the vagus nerve, which stimulates acid production. Choices A, C, and D are incorrect. A vagotomy does not increase acid secretion, promote gastric emptying, or remove the ulcerated area. It specifically aims to decrease acid production to help in the healing of peptic ulcers.

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