Nursing Elites

1. What is the primary goal of care for a client diagnosed with sickle cell anemia?

• A. The client will contact the healthcare provider if feeling unwell.
• B. The client will adhere to the medical regimen.
• C. The client will live as normal a life as possible.
• D. The client will demonstrate understanding of treatments.

Correct answer: C

Rationale: The primary goal of care for a client diagnosed with sickle cell anemia is to help them live as normal a life as possible. This involves managing symptoms, preventing crises, and promoting overall well-being. While options A, B, and D are important aspects of care, the ultimate goal is to enhance the client's quality of life and support them in leading a fulfilling and active lifestyle despite their condition.

2. The nurse is teaching basic cardiopulmonary resuscitation (CPR) to individuals in the community. Which is the order of basic CPR?

• A. Ensure the scene is safe, assess responsiveness, call for help, begin CPR with compressions, airway, and breathing
• B. Give two (2) rescue breaths
• C. Look, listen, and feel for breathing
• D. Begin chest compressions

Correct answer: A

Rationale: The correct order of basic CPR is to first ensure the scene is safe to approach, then assess responsiveness. Next, call for help and start CPR with chest compressions, followed by checking the airway and giving rescue breaths. Choice B is incorrect as giving rescue breaths is usually done after the initial chest compressions. Choice C is incorrect as looking, listening, and feeling for breathing comes after starting compressions. Choice D is incorrect as chest compressions are usually the first step in basic CPR.

3. A family came to the emergency department with complaints of food poisoning. Which client should the nurse see first?

• A. 32-year-old with diarrhea for 6 hours
• B. 2-year-old with 1 wet diaper in 24 hours
• C. 40-year-old with abdominal cramping
• D. 10-year-old who is nauseated

Correct answer: B

Rationale: In cases of food poisoning, a 2-year-old with reduced urine output is a critical finding indicating dehydration, requiring immediate attention to prevent complications. The reduced urine output is a sign of decreased fluid intake or increased fluid loss, putting the child at high risk for dehydration. This client should be seen first to assess hydration status, initiate necessary interventions, and prevent further complications. While the other symptoms presented by the other clients are concerning, the 2-year-old's decreased urine output poses the most immediate threat to their well-being.

4. The hypertonicity of the muscles in an infant with cerebral palsy causes scissoring of the legs. The nurse teaches the mother that the preferred way to carry the infant is in a sitting position:

• A. Astride one of her hips
• B. Strapped in an infant seat
• C. Wrapped tightly in a blanket
• D. Under the arm using a football hold

Correct answer: A

Rationale: The correct way to carry an infant with cerebral palsy experiencing muscle hypertonicity and scissoring of the legs is astride one of the mother's hips. This position helps keep the infant's legs apart, reducing muscle tightness. Strapping the infant in an infant seat, wrapping tightly in a blanket, or using the football hold under the arm does not address the specific needs related to muscle hypertonicity and scissoring of the legs in cerebral palsy.

5. After a pericardiocentesis, what interventions should the nurse implement?

• A. Monitor vital signs every 15 minutes for the first hour
• B. Evaluate the client’s cardiac rhythm
• C. Record the amount of fluid removed as output
• D. All of the above

Correct answer: D

Rationale: After a pericardiocentesis, the nurse should implement multiple interventions to monitor the client's condition closely. Monitoring vital signs every 15 minutes for the first hour is crucial to detect any immediate changes that may indicate complications. Evaluating the client's cardiac rhythm is important to identify any arrhythmias that may occur due to the procedure. Recording the amount of fluid removed is essential to calculate fluid balance and ensure accurate monitoring of the client's status. Therefore, all the interventions mentioned are necessary to detect and manage any potential issues post-pericardiocentesis. Choices A, B, and C are all essential components of post-procedural care and should be implemented to ensure the client's safety and well-being.

Similar Questions