Nursing Elites

1. A client with sleep apnea has been ordered a CPAP machine. Which action could the RN delegate to a nursing assistant?

• A. Reminding the client to apply the CPAP at bedtime
• B. Obtaining every three-hour oxygen saturation levels
• C. Teaching the client how to turn on the CPAP machine
• D. Assessing for fatigue or depression caused by poor sleep

Correct answer: A

Rationale: The correct answer is reminding the client to apply the CPAP at bedtime. This task can be safely delegated to a nursing assistant as it involves a simple and routine reminder. Option B, obtaining oxygen saturation levels, requires a higher level of training and interpretation of results, making it more appropriate for an RN. Option C, teaching the client how to turn on the CPAP machine, involves educating the client and ensuring proper use of medical equipment, which is within the RN's scope of practice. Option D, assessing for fatigue or depression, requires a comprehensive evaluation that involves interpreting symptoms and identifying underlying causes, making it more suitable for an RN to address.

2. The client in the Emergency Department, who has suffered an ankle sprain, should be taught to:

• A. use cold applications to the sprain during the first 24-48 hours.
• B. expect disability to decrease within the first 24 hours of injury
• C. expect pain to decrease within 3 hours after injury.
• D. begin progressive passive and active range of motion exercises immediately.

Correct answer: A

Rationale: When a client suffers an ankle sprain, the nurse should teach them to use cold applications to the sprain during the first 24-48 hours. Cold applications are believed to produce vasoconstriction and reduce the development of edema. Expecting disability to decrease within the first 24 hours of injury (choice B) is incorrect as disability and pain are anticipated to increase during the first 2-3 hours after injury. Expecting pain to decrease within 3 hours after injury (choice C) is also incorrect as pain and swelling usually increase initially. Beginning progressive passive and active range of motion exercises immediately (choice D) is not recommended; these exercises are usually started 2-5 days after the injury, according to the physician's recommendation. Treatment for a sprain involves support, rest, and alternating cold and heat applications. X-ray pictures are often necessary to rule out any fractures.

3. A healthcare professional is reviewing a patient's current Lithium levels. Which of the following values is outside the therapeutic range?

• A. 1.0 mEq/L
• B. 1.1 mEq/L
• C. 1.2 mEq/L
• D. 1.3 mEq/L

Correct answer: D

Rationale: The correct answer is 1.3 mEq/L. The therapeutic range for Lithium levels typically falls between 0.6 to 1.2 mEq/L. Values below or above this range can lead to suboptimal treatment outcomes or toxicity. Choices A, B, and C are within the therapeutic range of 1.0-1.2 mEq/L, making them appropriate levels for patient care.

4. When dressing a severe burn to the right hand, it is important for the nurse to:

• A. Apply a wet-to-dry dressing for debridement
• B. Wrap each digit individually to prevent webbing
• C. Open blisters to allow drainage prior to dressing
• D. Allow the client to do as much of the dressing change as possible

Correct answer: B

Rationale: When dressing a severe burn to the hand, it is crucial to wrap each digit individually to prevent webbing, which can lead to contractures and impaired function. Applying a wet-to-dry dressing for debridement is not recommended for burn wounds as it can cause trauma to the wound bed during removal. Opening blisters can increase the risk of infection and delay healing. Allowing the client to perform the dressing change may not ensure proper care and can lead to complications.

5. Which of the following lab values would indicate symptomatic AIDS in the medical chart? (T4 cell count per deciliter)

• A. Greater than 1000 cells per deciliter
• B. Less than 500 cells per deciliter
• C. Greater than 2000 cells per deciliter
• D. Less than 200 cells per deciliter

Correct answer: D

Rationale: A T4 cell count of less than 200 cells per deciliter indicates symptomatic AIDS. This severe depletion of T4 cells signifies advanced HIV infection and a significantly compromised immune system. Choices A, B, and C are incorrect because T4 cell counts above 2000, above 1000, or below 500 cells per deciliter, respectively, are not indicative of symptomatic AIDS.

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