Nursing Elites

1. A healthcare professional is asked to draw blood in the antecubital (AC) space. Which of the following veins are found in the AC?

• A. Cephalic
• B. Median cubital
• C. Basilic
• D. All of the above

Correct answer: D

Rationale: The correct answer is 'All of the above.' All three of these veins - the cephalic, median cubital, and basilic veins - are located in the antecubital space, which is the area in front of the elbow on the arm. The cephalic vein runs along the outer side of the arm, the basilic vein runs along the inner side of the arm, and the median cubital vein is a connecting vein between the cephalic and basilic veins. Therefore, all three veins can be accessed when drawing blood from the antecubital space. Choices A, B, and C are incorrect because each of these veins individually can be found in the antecubital space.

2. What is a common error when taking a pulse?

• A. Placing the index finger on the radial artery located on the thumb side of a patient's wrist.
• B. Noting a pulse as 'weak' when the pulsation disappears upon adding pressure.
• C. Counting the pulse for 15 seconds and multiplying the number by four.
• D. None of the above will cause errors.

Correct answer: C

Rationale: The correct answer is counting the pulse for 15 seconds and multiplying the number by four. To accurately assess a patient's heart rate or pulse, it is crucial to count the pulse for a full minute. Counting for only 15 seconds and then multiplying by four may result in an inaccurate heart rate calculation. This approach could miss arrhythmias or intermittent pulsations that could be vital indicators of the patient's condition. Placing the index finger on the radial artery, which is located on the thumb side of the patient's wrist, is the correct technique for taking a pulse. Noting a pulse as 'weak' when the pulsation disappears upon adding pressure is a valid observation and not an error in itself. Therefore, the most common error in this scenario is incorrectly calculating the pulse rate by multiplying a 15-second count by four.

3. A nurse is preparing to change a client's dressing for a burn wound on his foot. Which of the following interventions is appropriate for this process?

• A. Wash the wound with cleanser, rinse, and pat dry
• B. Bind the wound tightly, secure with tape, and elevate the foot
• C. Contact the physician after the dressing change is complete
• D. Provide analgesics for the client after the procedure

Correct answer: A

Rationale: When changing the dressing for a burn wound, it is essential to follow appropriate interventions to prevent infection, reduce pain, and support healing. In this scenario, after removing the old dressing, it is crucial to wash the wound gently with a suitable cleanser, rinse the area thoroughly, and then pat it dry. This process helps in maintaining cleanliness, reducing the risk of infection, and providing a conducive environment for healing. Binding the wound tightly (Choice B) can impede circulation and delay healing. Contacting the physician after the dressing change (Choice C) may be necessary in specific situations but is not a standard step in routine dressing changes. Providing analgesics after the procedure (Choice D) is important for pain management but is not directly related to the dressing change itself.

4. During a seminar on cultural aspects of nursing, the nurse recognizes that the definition stating, "the specific and distinct knowledge, beliefs, customs, and skills acquired by members of a society,"? reflects which term?

• A. Norms
• B. Culture
• C. Ethnicity
• D. Assimilation

Correct answer: B

Rationale: The term that best fits the provided definition, which includes knowledge, beliefs, customs, and skills acquired by members of a society, is 'Culture.' Culture is a broad concept encompassing various aspects of a society's way of life. Norms refer to typical behaviors or rules within a society. Ethnicity pertains to shared traits among a social group, such as origin, religion, language, and traditions. Assimilation involves adopting the dominant culture's characteristics, often through integration or conformity.

5. Your patient ate an 8-ounce cup of Italian ice. How much will you record on the patient's Intake and Output form in terms of this patient's fluid intake?

• A. 240 cc
• B. 120 cc
• C. 8 cc
• D. 0 cc because Italian ice is not a fluid

Correct answer: A

Rationale: The correct answer is 240 cc. Italian ice is considered a fluid, so you would record the intake of 240 cc. Choice B (120 cc) and Choice C (8 cc) are incorrect as they do not reflect the correct amount of fluid intake from an 8-ounce cup of Italian ice. Choice D (0 cc) is incorrect because Italian ice does count as a fluid intake and should be recorded as such.

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