Nursing Elites

1. A client is admitted with a diagnosis of fluid volume deficit. Which clinical finding would the nurse expect?

• A. Bounding pulse
• B. Bradycardia
• C. Oliguria
• D. Dry mucous membranes

Correct answer: D

Rationale: Dry mucous membranes (D) are a common clinical finding indicating fluid volume deficit. In dehydration, there is insufficient fluid in the body, leading to dry mucous membranes due to decreased saliva production. Bounding pulse (A) is associated with fluid volume excess, not deficit. Bradycardia (B) and oliguria (C) are not typical clinical findings of fluid volume deficit but may be seen in fluid volume excess or other conditions.

2. After informing an older client that an IV line needs to be inserted, the client becomes very apprehensive, loudly expressing a dislike for all healthcare providers and nurses. How should the nurse respond?

• A. Ask the client to remain quiet so the procedure can be performed safely.
• B. Concentrate on completing the insertion as efficiently as possible.
• C. Calmly reassure the client that the discomfort will be temporary.
• D. Tell the client a joke as a means of distraction from the procedure.

Correct answer: C

Rationale: In this situation, the nurse should respond by calmly reassuring the client that the discomfort from the IV insertion will be temporary. By providing reassurance and addressing the client's concerns, the nurse can help reduce the client's apprehension and create a more supportive environment for the procedure.

3. While suctioning a tracheostomy tube, the client starts to cough. What is the best action for the nurse to take?

• A. Suction deeper to remove secretions.
• B. Gently withdraw suction tubing to allow suction or coughing out of mucus.
• C. Remove the suction as quickly as possible.
• D. Insert and remove the suction multiple times to clear secretions.

Correct answer: B

Rationale: When a client coughs during tracheostomy tube suctioning, the nurse should gently withdraw the suction tubing. This action allows the client to cough out mucus naturally, reducing the risk of further irritation and promoting effective airway clearance. Choice A is incorrect because suctioning deeper can cause trauma and increase the risk of complications. Choice C is incorrect as removing the suction quickly may not allow the client to clear the mucus adequately. Choice D is incorrect as inserting and removing the suction multiple times can lead to unnecessary trauma and discomfort for the client.

4. Why is it most important to start intravenous infusions in the upper extremities rather than the lower extremities of adults?

• A. Superficial veins are more easily found in the feet and ankles.
• B. A decreased flow rate could lead to thrombosis formation.
• C. It is more challenging to move a cannulated extremity when using the leg or foot.
• D. Veins in the feet and ankles are located deep, making the procedure more painful.

Correct answer: B

Rationale: The most critical reason for initiating intravenous infusions in the upper extremities of adults is to reduce the risk of thrombosis (B). Venous return is typically better in the upper extremities, decreasing the likelihood of thrombus formation, which could be life-threatening if dislodged. Although superficial veins are easily found in the feet and ankles (A), this is not the primary reason for choosing the upper extremities. Handling a leg or foot with an IV (C) is not significantly more challenging than handling an arm or hand. The depth of veins in the feet and ankles (D) does not primarily determine the site for IV placement.

5. A male healthcare provider is assigned to care for a female Muslim client. When the provider offers to bathe the client, the client requests that a female healthcare provider perform this task. How should the male healthcare provider respond?

• A. May I ask a female colleague to help you with your personal hygiene?
• B. I will ask one of the female healthcare providers to bathe you.
• C. A staff member on the next shift will help you.
• D. I will keep you draped and hand you the supplies as you need them.

Correct answer: B

Rationale: The most culturally sensitive response is for the male healthcare provider to ask one of the female healthcare providers to bathe the client. This approach respects the client's cultural and spiritual preferences by ensuring that their modesty and beliefs are honored during the care process. Choice A is incorrect as it puts the responsibility on the client to seek help, while the provider should take the initiative to arrange for appropriate care. Choice C is incorrect as it delays the assistance unnecessarily. Choice D, although helpful in maintaining modesty, does not address the client's request for a female healthcare provider to perform the task.

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