Nursing Elites

1. During a physical assessment of adult clients, which of the following techniques should the nurse use?

• A. Use the Face, Legs, Activity, Cry, and Consolability (FLACC) pain rating scale for a client experiencing pain.
• B. Palpate the client's abdomen before auscultating bowel sounds.
• C. Ensure the bladder of the blood pressure cuff surrounds 80% of the client's arm.
• D. Obtain an apical heart rate by auscultating at the third intercostal space to the left of the sternum.

Correct answer: B

Rationale: When performing a physical assessment, it is essential to palpate the client's abdomen before auscultating bowel sounds. This sequence helps prevent altering bowel sound results due to the pressure applied during palpation. Choice A is incorrect because the FLACC pain rating scale is typically used for nonverbal or pediatric clients, not adults. Choice C is incorrect because the bladder of the blood pressure cuff should surround about 80% of the client's arm circumference, not the bladder of the cuff itself. Choice D is incorrect because to obtain an apical heart rate, auscultation should be done at the fifth intercostal space at the midclavicular line, not at the third intercostal space to the left of the sternum.

2. Nurse Managers work with staff to educate them about ways to diffuse potentially violent situations. Which of the following diagnoses can staff expect to be more frequently associated with violence?

• A. Alcohol or drug withdrawal
• B. Anxiety
• C. Depression
• D. Confusion

Correct answer: A

Rationale: Alcohol or drug withdrawal is more frequently associated with violence as these conditions alter a person's inhibitions. Gilmore (2006) highlights that working with the public involves inherent risks and stressors. Individuals with head trauma, mental illnesses, and those withdrawing from substances are more likely to respond with violence. Anxiety, depression, and confusion do not typically lead to increased violent behavior compared to conditions involving substance withdrawal.

3. Attending a continuing education class on advanced technology in health care is interpreted as which of the following by the nurse manager?

• A. Only important for nurse managers
• B. Not important
• C. A waste of time
• D. Essential to nursing care

Correct answer: D

Rationale: The correct answer is D: 'Essential to nursing care.' Advancements in technology play a crucial role in modern healthcare delivery. By attending a class on advanced technology, the staff nurse can enhance their skills and knowledge, ultimately benefiting nursing care. Choices A, B, and C are incorrect because advanced technology is not exclusive to nurse managers, is important for improving patient care, and is not a waste of time as it helps nurses stay updated with the latest advancements.

4. Which of the following is a challenge the profession of nursing faced?

• A. Nursing contributing to the stigma of AIDS in the 1980s out of fear.
• B. Nursing practice flourishing in field hospitals during the Korean War with abundant supplies and equipment.
• C. Many nurses feeling frustrated with the lack of independent functioning after the Vietnam War.
• D. A decline in the number of hospice nurses due to ethical dilemmas.

Correct answer: C

Rationale: The correct answer is C. After the Vietnam War, many nurses felt frustrated with the lack of independent functioning when they returned home. This challenge was faced by the profession of nursing as nurses who functioned independently in mobile hospital units during the war found themselves restricted in their practice upon returning. Choices A, B, and D are incorrect because they do not address the specific challenge of lack of independent functioning faced by nurses after the Vietnam War.

5. A client who had a stroke resulting in aphasia and dysphagia needs assistance. Which of the following tasks should the nurse assign to an assistive personnel (AP)?

• A. Assist the client with a partial bed bath.
• B. Measure the client's BP after the nurse administers an antihypertensive medication.
• C. Test the client's swallowing ability by providing thickened liquids.
• D. Use a communication board to ask what the client wants for lunch.

Correct answer: A

Rationale: The correct answer is A because assisting the client with a partial bed bath is within the scope of practice for an assistive personnel and does not require specialized medical knowledge. Choice B involves measuring BP, which requires specific training and assessment skills that an assistive personnel may not have. Choice C involves testing swallowing ability, which should be done by a healthcare provider due to the risks involved in dysphagia. Choice D involves communication, which is crucial but should be done by someone with training in managing aphasia to ensure effective communication with the client.

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