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. When designing a home health care program for disabled children, which factor should be considered when assessing reimbursement for services from private insurance companies?

• A. greater access to any healthcare provider
• B. allowance for early discharge
• C. concern for the quality of care
• D. approval by the network healthcare provider

Correct answer: D

Rationale: When assessing reimbursement for services from private insurance companies, approval by the network healthcare provider is crucial. This approval ensures that the services provided are within the approved network, allowing for reimbursement. Choices A, B, and C are not directly related to the reimbursement process by private insurance companies. While greater access to any healthcare provider, allowance for early discharge, and concern for the quality of care are important considerations when designing a home health care program, they do not specifically impact the reimbursement process from private insurance companies.

3. Which topic should the nurse include in planning a primary prevention class for adolescents?

• A. Risk factors for heart disease.
• B. Dietary management of obesity.
• C. Suicide risks and prevention.
• D. Coping with stressful situations.

Correct answer: C

Rationale: The correct topic that the nurse should include in planning a primary prevention class for adolescents is suicide risks and prevention. Adolescents are particularly vulnerable to mental health issues, including suicidal ideation. Educating them about suicide risks and prevention strategies is crucial for early intervention and support. Choices A, B, and D are important topics, but when considering primary prevention for adolescents, addressing suicide risks and prevention takes precedence due to its immediate life-saving implications.

4. Which individual has the highest risk of developing community-acquired pneumonia?

• A. A 40-year-old first-grade teacher who works with underprivileged children.
• B. A 75-year-old retired secretary with exercise-induced wheezing.
• C. A 60-year-old homeless person who is an alcoholic and smokes.
• D. A 35-year-old aerobics instructor who skips meals and eats only vegetables.

Correct answer: C

Rationale: The correct answer is the 60-year-old homeless person who is an alcoholic and smokes. This individual has the highest risk of developing community-acquired pneumonia due to factors such as homelessness, alcoholism, and smoking, which weaken the immune system and make them more susceptible to respiratory infections. Choice A is incorrect as working with underprivileged children, while potentially exposing the individual to various illnesses, does not directly increase the risk of pneumonia. Choice B is less likely as exercise-induced wheezing may suggest asthma but does not directly correlate with pneumonia risk. Choice D, an aerobics instructor who eats only vegetables and skips meals, does not have the same level of risk factors for pneumonia as the homeless person in choice C.

5. A 19-year-old client is paralyzed in a car accident. Which statement used by the client would indicate to the nurse that the client was using the mechanism of 'suppression'?

• A. "I don't remember anything about what happened to me."
• B. "I'd rather not talk about it right now."
• C. "It's all the other guy's fault! He was going too fast."
• D. "My mother is heartbroken about this."

Correct answer: B

Rationale: The correct answer is B because the statement "I'd rather not talk about it right now" indicates that the client is consciously choosing to avoid discussing the distressing issue, which aligns with the mechanism of suppression. Choice A does not involve active avoidance but rather memory loss, which is not suppression. Choice C involves blaming others, which is a defense mechanism known as projection. Choice D involves expressing emotions rather than avoiding them, which does not align with suppression.

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