Nursing Elites

1. A nurse is assessing a client who has Clostridium difficile (C. diff) infection. Which infection control measure should the nurse implement?

• A. Wear a face shield when entering the room
• B. Place the client in a private room
• C. Place the client in a negative pressure room
• D. Use alcohol-based hand rub following client care

Correct answer: B

Rationale: The correct answer is to place the client in a private room. Clostridium difficile (C. diff) infection requires contact precautions, which include isolating the client in a private room to prevent the spread of infection to others. Wearing a face shield may be necessary in certain situations for protection but is not the primary measure for C. diff. Placing the client in a negative pressure room is not specifically indicated for C. diff unless the client has additional respiratory issues. Using alcohol-based hand rub following client care is not sufficient for C. diff control; thorough handwashing with soap and water is recommended due to the spore-forming nature of C. diff.

2. A nurse in a clinic is caring for a patient who has a UTI. What prescription should the nurse verify with a provider?

• A. Ciprofloxacin
• B. Trimethoprim-sulfamethoxazole
• C. Oxybutynin
• D. Nitrofurantoin

Correct answer: C

Rationale: The correct answer is C: Oxybutynin. Oxybutynin is an anticholinergic used to treat overactive bladder, not a UTI. The nurse should verify this prescription because it may not be appropriate for a UTI. Choices A, B, and D are antibiotics commonly used in the treatment of UTIs. Ciprofloxacin, trimethoprim-sulfamethoxazole, and nitrofurantoin are more suitable choices for the treatment of a UTI compared to oxybutynin.

3. A nurse is preparing to feed a newly admitted client with dysphagia. Which of the following actions should the nurse take?

• A. Instruct the client to lift their chin when swallowing
• B. Discourage the client from coughing during feedings
• C. Sit at or below the client’s eye level during feedings
• D. Talk with the client during feedings

Correct answer: C

Rationale: The correct answer is C. Sitting at or below the client’s eye level is important when feeding a client with dysphagia. This position allows the nurse to closely observe the client for any signs of difficulty with swallowing, which can help prevent aspiration. Instructing the client to lift their chin when swallowing (choice A) is not recommended for clients with dysphagia as it can increase the risk of aspiration. Discouraging the client from coughing during feedings (choice B) is also not correct, as coughing may be a protective mechanism to prevent aspiration. Talking with the client during feedings (choice D) may distract the client and interfere with their ability to focus on swallowing safely.

4. A nurse is preparing to administer regular insulin and NPH insulin. What is the proper sequence of events the nurse should follow?

• A. Inspect the vials for contamination.
• B. Withdraw regular insulin first, then NPH.
• C. Inject air into the NPH insulin vial first.
• D. Roll the NPH insulin vial between the hands to mix.

Correct answer: A

Rationale: The correct sequence of events for administering regular insulin and NPH insulin begins with inspecting the vials for contamination to ensure patient safety. Rolling the NPH insulin vial between the hands to mix and injecting air into the NPH insulin vial should follow the inspection step. Afterward, the nurse should inject air into the regular insulin vial and then withdraw the regular insulin first. Option A is the correct answer as it outlines the initial crucial step in the administration process. Option B is incorrect as it provides the incorrect order of withdrawing the insulins. Option C is incorrect as injecting air into the NPH insulin vial should come after inspecting the vials. Option D is incorrect as rolling the NPH insulin vial should be done after inspecting the vials and injecting air into the NPH insulin vial.

5. A client is preparing advance directives. Which of the following statements by the client indicates an understanding of advance directives?

• A. I cannot change my instructions once they are made
• B. My doctor will need to approve my advance directives
• C. I need an attorney to witness my signature on the advance directives
• D. I have the right to refuse treatment

Correct answer: D

Rationale: The correct answer is D: 'I have the right to refuse treatment.' This statement indicates an understanding of advance directives because advance directives allow individuals to express their treatment preferences, including the right to refuse treatment if they choose to do so. Choice A is incorrect because individuals can update or change their advance directives as needed. Choice B is incorrect because advance directives are based on the individual's preferences, not the doctor's approval. Choice C is incorrect as witnessing an advance directive typically requires a witness who is not an attorney, depending on the state's specific requirements.

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