Nursing Elites

1. A 3-year-old child has had multiple tooth extractions while under general anesthesia. The client returns from the post-anesthesia care unit crying but awake. Which approach is likely to be successful?

• A. Examine the mouth first
• B. Reassure the child
• C. Examine the mouth last
• D. Offer a pacifier

Correct answer: C

Rationale: In this scenario, it is crucial to prioritize the comfort of the child. By examining the mouth last, discomfort is minimized, and the child is given the opportunity to settle down. Choosing to examine the mouth first may escalate the distress of the child further. While reassuring the child is important, in this case, addressing the physical discomfort before providing emotional reassurance is more effective. Offering a pacifier may provide some comfort, but addressing the immediate physical discomfort by examining the mouth last is the most appropriate action to help the child settle down after the procedure.

2. The patient is receiving chemotherapy for breast cancer. Which of the following laboratory values would be most important to monitor?

• A. White blood cell count
• B. Hemoglobin level
• C. Serum creatinine
• D. Blood glucose level

Correct answer: A

Rationale: Monitoring the white blood cell count is crucial when a patient is undergoing chemotherapy for breast cancer. Chemotherapy can lead to neutropenia, a condition of low white blood cell count, which significantly increases the risk of infections. Monitoring white blood cell count helps healthcare providers intervene promptly to prevent severe infections. Hemoglobin level, while important in assessing oxygen-carrying capacity, is not the priority in this scenario. Serum creatinine and blood glucose levels are not directly impacted by chemotherapy for breast cancer.

3. The healthcare provider is assessing a client with a diagnosis of chronic obstructive pulmonary disease (COPD). Which assessment finding would be most concerning?

• A. Barrel chest
• B. Clubbing of the fingers
• C. Cough with sputum production
• D. Use of accessory muscles

Correct answer: D

Rationale: The use of accessory muscles is the most concerning finding in a client with COPD. It indicates increased work of breathing and may signal respiratory distress, requiring immediate attention. Barrel chest is a common physical characteristic in individuals with COPD due to chronic air trapping and hyperinflation of the lungs but is not as acutely concerning as the use of accessory muscles. Clubbing of the fingers is a late sign of chronic hypoxia and is often seen in conditions with prolonged hypoxemia but is not as acute as the use of accessory muscles. Cough with sputum production is a common symptom in COPD due to excess mucus production but does not indicate immediate respiratory distress as the use of accessory muscles does.

4. An elderly resident of a long-term care facility is no longer able to perform self-care and is becoming progressively weaker. The resident previously requested that no resuscitative efforts be performed, and the family requests hospice care. What action should the LPN/LVN implement first?

• A. Reaffirm the client's desire for no resuscitative efforts.
• B. Transfer the client to a hospice inpatient facility.
• C. Prepare the family for the client's impending death.
• D. Notify the healthcare provider of the family's request.

Correct answer: D

Rationale: The first action the LPN/LVN should implement is to notify the healthcare provider of the family's request. This is crucial to ensure that appropriate steps are taken to address the family's request for hospice care and to coordinate the necessary care for the resident. While reaffirming the client's desire for no resuscitative efforts is important, notifying the healthcare provider takes precedence in this situation. Transferring the client to a hospice inpatient facility and preparing the family for the client's impending death are significant actions but should be done after notifying the healthcare provider to ensure proper coordination of care.

5. During a follow-up visit, a home health nurse notices that a client with a gastrostomy tube, who receives intermittent feedings and medications, has developed diarrhea. Which of the following findings should the nurse identify as a possible cause of the diarrhea?

• A. The client’s caregiver washes out the feeding bag once every 24 hours with warm water.
• B. The client’s caregiver washes out the feeding bag with hot water every 24 hours.
• C. The client’s caregiver changes the feeding bag every 48 hours.
• D. The client’s caregiver adds water to the formula before administration.

Correct answer: A

Rationale: The correct answer is A. Washing out the feeding bag once every 24 hours with warm water can lead to bacterial growth due to inadequate cleaning, potentially causing diarrhea. Hot water, as in choice B, can also promote bacterial growth, which is not desirable. Changing the feeding bag every 48 hours, like in choice C, is within an acceptable timeframe and is unlikely to be a cause of diarrhea. Adding water to the formula before administration, as in choice D, is a common practice to dilute the formula but is not typically associated with causing diarrhea in this scenario.

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