Nursing Elites

1. After a client has a tubal ligation in the outpatient surgical clinic, what is the priority for the nurse to determine?

• A. The client's prior experiences with outpatient surgery
• B. The client's medical plan and the extent of coverage for outpatient surgery
• C. The client's plan for transportation and care at home
• D. The client's plan to spend the night at the surgical center

Correct answer: C

Rationale: The priority for the nurse is to ensure the client has a safe way to get home and adequate care after discharge. It is crucial to determine the client's transportation arrangements and availability of care at home to ensure a smooth transition postoperatively. Options A and B, though important, are not immediate priorities compared to the client's safety and well-being after the procedure. Option D is incorrect as spending the night at the surgical center is not typically part of the plan for outpatient surgery.

2. The client diagnosed with end-stage liver disease has completed an advance directive and a do-not-resuscitate (DNR) document and wishes to receive palliative care. Which of the following would correspond to the client's wish for comfort care?

• A. Positioning frequently to prevent skin breakdown and providing pain management and other comfort measures
• B. Carrying out vigorous resuscitation efforts if the client were to stop breathing, but no resuscitation if the heart stops beating
• C. Providing intravenous fluids when the client becomes dehydrated
• D. Providing total parenteral nutrition (TPN) if the client is not able to eat

Correct answer: A

Rationale: Palliative care includes measures to prevent skin breakdown, pain management, and management of other symptoms that cause discomfort, as well as encouraging contact with family and friends. A DNR request precludes all resuscitative efforts related to respiratory or cardiac arrest, making choice B incorrect. Dehydration is a natural part of the dying process, so providing intravenous fluids as in choice C would not align with the client's wish for comfort care. Total parenteral nutrition (TPN) as in choice D is an invasive procedure meant to prolong life and is not part of palliative care, which focuses on improving quality of life rather than extending it.

3. What is the best position for a client immediately following a bilateral salpingooophorectomy?

• A. Fowler's
• B. Modified Sims
• C. Side lying
• D. Flat supine

Correct answer: C

Rationale: The best position for a client immediately following a bilateral salpingooophorectomy is side lying. This position promotes comfort with the knees flexed and ensures proper airway management. Fowler's position (Choice A) would not be ideal as it involves sitting at a 90-degree angle, potentially causing discomfort after this procedure. Modified Sims position (Choice B) is typically used for rectal examinations, not for post-surgical management. Flat supine (Choice D) may not be the best choice immediately after surgery as it does not provide the same level of comfort and airway protection as side lying with knees flexed.

4. After discontinuing a peripherally inserted central line (PICC), what information is most important for the nurse to record?

• A. How the client tolerated the procedure.
• B. The length and intactness of the central line catheter.
• C. The amount of fluid left in the IV solution container.
• D. That a dressing was applied to the insertion site.

Correct answer: B

Rationale: The most important information for the nurse to record after discontinuing a peripherally inserted central line (PICC) is the length and intactness of the central line catheter. This is crucial for assessing any potential complications or safety issues post-removal. Choices A, C, and D are not as critical as ensuring the condition of the central line catheter. While noting the client's tolerance of the procedure is relevant for their care assessment, evaluating the central line's integrity takes precedence in this scenario.

5. The emergency department charge nurse is reviewing the clients triaged in the last 30 minutes. The nurse is required to obtain a social service consult from which of the following clients?

• A. A 6-year-old who drank some diluted bleach.
• B. A 10-year-old who suffered burns in a house fire.
• C. A 12-year-old who fractured his arm in a fight at school.
• D. A 12-month-old without any oral intake for the last 12 hours.

Correct answer: A

Rationale: For children under 7 years, most states have laws that mandate reporting certain situations to social services or child protection, such as ingestions of toxic substances, fractures, suspected neglect, or abuse, and burns. In this scenario, the 6-year-old who drank diluted bleach falls under the category that requires a social service consult. The other choices involve injuries or conditions that may warrant medical attention but do not necessarily mandate a social service consult based on age-related legal requirements.

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