Nursing Elites

1. A male patient who had surgery 2 days ago for head and neck cancer is about to make his first attempt to ambulate outside his room. The nurse notes that he is steady on his feet and that his vision was unaffected by the surgery. Which of the following nursing interventions would be appropriate?

• A. Encourage the patient to walk in the hall alone
• B. Discourage the patient from walking in the hall for a few more days
• C. Accompany the patient for his walk
• D. Consult a physical therapist before allowing the patient to ambulate

Correct answer: C

Rationale: Accompanying the patient for his walk is the appropriate nursing intervention in this scenario to ensure his safety during his first ambulation. This allows the nurse to provide immediate assistance if needed and ensures the patient's well-being during this critical postoperative period.

2. In Maslow’s hierarchy of physiological needs, the human need of greatest priority is:

• A. Love
• B. Elimination
• C. Nutrition
• D. Oxygen

Correct answer: D

Rationale: In Maslow’s hierarchy of physiological needs, the most basic and immediate need is physiological survival, which includes the need for oxygen. Without oxygen, the body cannot survive for more than a few minutes, making it the highest priority physiological need according to Maslow's hierarchy.

3. How many drops are equivalent to 1 tsp?

• A. 15
• B. 60
• C. 10
• D. 30

Correct answer: B

Rationale: 1 teaspoon (tsp) is equivalent to approximately 60 drops. Drops and teaspoons vary in volume and size, affecting the conversion ratio. Choice A (15 drops) is incorrect as it's a common misconception. Choice C (10 drops) and Choice D (30 drops) do not align with the standard conversion of 1 tsp to 60 drops.

4. A client has diaper dermatitis. Which of the following actions should the nurse take?

• A. Apply zinc oxide ointment to the irritated area.
• B. Wipe stool from the skin using store-bought baby wipes.
• C. Apply talcum powder to the irritated area.
• D. None of the above

Correct answer: A

Rationale: Diaper dermatitis, also known as diaper rash, is a common condition in babies or clients who wear diapers. The primary intervention for diaper dermatitis is to apply a protective barrier cream, such as zinc oxide ointment, to the irritated area. This helps to protect the skin from irritants and promotes healing. Wiping stool from the skin using baby wipes may further irritate the skin, and talcum powder is no longer recommended due to potential respiratory risks when inhaled. Therefore, the correct action for the nurse in this scenario is to apply zinc oxide ointment to the irritated area.

5. A healthcare professional in an emergency department is assessing a newly admitted client who is experiencing drooling and hoarseness following a burn injury. Which of the following actions should the healthcare professional take first?

• A. Obtain a baseline ECG.
• B. Obtain a blood specimen for ABG analysis.
• C. Insert an 18-gauge IV catheter.
• D. Administer 100% humidified oxygen.

Correct answer: D

Rationale: In a client experiencing drooling and hoarseness following a burn injury, airway compromise is a critical concern. Administering 100% humidified oxygen is the priority to ensure adequate oxygenation. This intervention takes precedence over obtaining baseline ECG, obtaining blood specimens, or inserting an IV catheter, as airway management and oxygenation are fundamental in the initial assessment and management of a client with potential airway compromise.

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