Nursing Elites

1. The nurse instructs a client 5 days after a lumbar laminectomy with spinal fusion about how to move from a supine position to standing at the left side of the bed with a walker. Which of the following directions by the nurse is BEST?

• A. Raise the head of the bed so you are sitting straight up, bend your knees, and swing your legs to the side and then to the floor
• B. Rock your body from side to side, going further each time until you build up enough momentum to be lying on your right side, and then raise your trunk toward your toes
• C. Reach over to the left side rail with your right hand, pull your body onto its side, bend your upper leg so the foot is on the bed, and push down to elevate your trunk
• D. Focus on using your arms, the left elbow as a pivot with the left hand grasping the mattress edge and the right hand pushing on the mattress above the elbow, then slide your legs over the side of the mattress

Correct answer: C

Rationale: Choice C is the best direction provided by the nurse. This method involves reaching over to the left side rail with the right hand, pulling the body onto its side, bending the upper leg so the foot is on the bed, and pushing down to elevate the trunk. This approach helps maintain spinal alignment while moving from a lying to a standing position, reducing strain on the back. Choices A, B, and D involve movements that are not suitable for a client recovering from a lumbar laminectomy with spinal fusion and could potentially cause harm or discomfort.

2. Patients with gallbladder disease should reduce their intake of:

• A. Protein
• B. Sodium
• C. Cholesterol
• D. Fat

Correct answer: D

Rationale: Patients with gallbladder disease should reduce their intake of fat because high-fat foods can trigger gallbladder symptoms such as pain and indigestion. While proteins, sodium, and cholesterol may also need to be moderated for overall health, reducing fat intake is particularly crucial for managing gallbladder issues.

3. The nurse is preparing the plan of care for a client with fluid volume deficit. Which interventions should the nurse include in the plan of care?

• A. Monitor vital signs every two (2) hours until stable
• B. Weigh the client in the same clothing at the same time daily
• C. Administer mouth care every eight (8) hours
• D. A, B, and C

Correct answer: D

Rationale: The correct interventions for a client with fluid volume deficit include monitoring vital signs every two hours until stable, weighing the client in the same clothing at the same time daily, and assessing skin turgor. Monitoring vital signs helps in early detection of changes, daily weighing can indicate fluid retention or loss, and skin turgor assessment is a reliable indicator of hydration status. Administering mouth care every eight hours is not directly related to managing fluid volume deficit and should not be included in the plan of care for this specific condition.

4. Management experience prepares the practical nurse to be a Clinical NCO or a Senior Clinical NCO. These positions are normally held by which of the following?

• A. Army Nurse Corps officer
• B. First Sergeant
• C. E6, E7, or E8
• D. E3, E4, or E5

Correct answer: C

Rationale: The correct answer is C: E6, E7, or E8. Clinical NCO or Senior Clinical NCO positions are typically held by individuals at the E6, E7, or E8 pay grades in the military. These positions require a higher level of experience and leadership, which align with the ranks of E6, E7, or E8. Choices A, B, and D are incorrect because Army Nurse Corps officers, First Sergeants, E3, E4, or E5 are not the typical ranks that hold Clinical NCO positions.

5. The nurse teaches the mother of an infant how to care for her infant following repair of a cleft lip. It is MOST important for the nurse to include which of the following instructions?

• A. Feed the infant with a newborn nipple while holding him in the recumbent position
• B. Clean the suture site with a cotton-tipped swab soaked in Betadine
• C. Place the infant in the prone position after feeding
• D. Feed the infant with a rubber-tipped syringe and burp frequently

Correct answer: D

Rationale: The correct answer is D because feeding the infant with a rubber-tipped syringe reduces the risk of injury to the surgical site and prevents aspiration. Choice A is incorrect because feeding in the recumbent position can increase the risk of aspiration. Choice B is incorrect as Betadine is not recommended for wound care near the mouth due to its potential toxicity if ingested. Choice C is incorrect because placing the infant in the prone position after feeding can increase the risk of regurgitation and aspiration.

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