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1. While eating at a restaurant, a gravid woman begins to choke and is unable to speak. What action should the nurse who witnesses the event take?
- A. Cardiopulmonary resuscitation with uterine tilt
- B. The Heimlich maneuver using chest thrusts
- C. The Heimlich maneuver using subdiaphragmatic thrusts
- D. Call 911 immediately then begin cardiopulmonary resuscitation
Correct answer: C
Rationale: The correct action for the nurse to take when a pregnant woman is choking and unable to speak is to perform the Heimlich maneuver using subdiaphragmatic thrusts. This technique is recommended for a pregnant woman to prevent harm to the fetus. Option A, cardiopulmonary resuscitation with uterine tilt, is not indicated for a choking episode. Option B, the Heimlich maneuver using chest thrusts, can potentially harm the gravid uterus. Option D, calling 911 immediately before providing assistance, can lead to a delay in addressing the immediate choking emergency.
2. The nurse assesses an older adult who is newly admitted to a long-term care facility. The client has dry, flaky skin and long thickened fingernails. The client has a medical history of a stroke which resulted in left-sided paralysis and dysphagia. In planning care for the client, which task should the nurse delegate to the unlicensed personnel (UAP)?
- A. Soak and file fingernails
- B. Offer fluids frequently
- C. Monitor skin elasticity
- D. Ambulate in the hallway
Correct answer: A
Rationale: Soaking and filing fingernails is a task that can be delegated to UAP. This task does not require specialized nursing skills and can be safely performed by unlicensed personnel. Offering fluids frequently, monitoring skin elasticity, and ambulating require more skilled assessments and interventions, which are responsibilities of the nurse. The client's dry, flaky skin and long thickened fingernails indicate the need for basic hygiene care, making it appropriate for delegation to unlicensed personnel.
3. The nurse notes that a depressed female client has been more withdrawn and non-communicative during the past two weeks. Which intervention is most important to include in the updated plan of care for this client?
- A. Encourage the client's family to visit more often
- B. Schedule a daily conference with the social worker
- C. Encourage the client to participate in group activities
- D. Engage the client in a non-threatening conversation
Correct answer: D
Rationale: Engaging the client in a non-threatening conversation is crucial as it can help build trust and provide support, addressing the client's withdrawal. This intervention focuses on establishing a therapeutic relationship and giving the client an opportunity to express their feelings. Choices A, B, and C do not directly target the client's need for communication and may not address the underlying issues contributing to her withdrawal. Encouraging the client's family to visit more often (Choice A) may add pressure or discomfort to the client. Scheduling a daily conference with the social worker (Choice B) may not address the client's immediate need for communication. Encouraging the client to participate in group activities (Choice C) may be overwhelming for the client and not address her withdrawal directly.
4. Following an open reduction and internal fixation of a compound fracture of the leg, a male client complains of “a tingly sensation” in his left foot. The nurse determines the client’s left pedal pulses are diminished. Based on these findings, what is the client’s greatest risk?
- A. Reduce pulmonary ventilation and oxygenation related to fat embolism.
- B. Neurovascular and circulation compromise related to compartment syndrome.
- C. Wound infection and delayed healing due to fractured bone protrusion.
- D. Venous stasis and thrombophlebitis related to postoperative immobility.
Correct answer: B
Rationale: The correct answer is B. Compartment syndrome is a serious condition that can occur following trauma or surgery, leading to compromised neurovascular status in the affected limb. Symptoms include pain, paresthesia (tingling sensation), and diminished pulses. If left untreated, compartment syndrome can result in tissue damage and potential loss of limb function. Options A, C, and D are incorrect because they do not directly address the neurovascular compromise associated with compartment syndrome.
5. Where should the nurse choose as the best location to begin a screening program for hypothyroidism?
- A. A business and professional women's group.
- B. An African-American senior citizens center.
- C. A daycare center in a Hispanic neighborhood.
- D. An after-school center for Native-American teens.
Correct answer: B
Rationale: The best location for beginning a screening program for hypothyroidism would be an African-American senior citizens center. This choice is the most suitable as hypothyroidism is more prevalent among older adults, and African-American seniors are at a higher risk for this condition due to various factors like genetics and lifestyle. Choices A, C, and D are less appropriate because hypothyroidism is not specifically linked to business and professional women, Hispanic children, or Native-American teens. Targeting the high-risk group, which in this case, are African-American seniors, increases the chances of successful screening and early detection.
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