Nursing Elites

1. A client who has just had a mastectomy has a closed wound suction device (hemovac) in place. Which nursing action will ensure proper operation of the device?

• A. Collapsing the device whenever it is 1/2 to 2/3 full of air.
• B. Emptying the device every 4 hours.
• C. Replacing the device every 24 hours.
• D. Keeping the device above the level of the surgical site.

Correct answer: A

Rationale: Collapsing the device when it is 1/2 to 2/3 full of air is the correct nursing action to ensure proper operation of a closed wound suction device (hemovac). This action maintains negative pressure, which is essential for proper suction and drainage of the wound. Emptying the device every 4 hours (Choice B) is not necessary as the focus should be on collapsing it appropriately. Replacing the device every 24 hours (Choice C) is not a standard practice unless indicated by the healthcare provider. Keeping the device above the level of the surgical site (Choice D) is not necessary for the device's proper operation; collapsing it to maintain negative pressure is the key action.

2. The healthcare provider is reviewing the signed operative consent with a client who is admitted for the removal of a lipoma on the left leg. The client states that the permit should include...

• A. Notify the surgeon of the client’s concern
• B. Have the client sign a new surgical permit
• C. Add the client’s concern to the permit
• D. Inform the surgeon about the client’s concern

Correct answer: D

Rationale: In this scenario, the best course of action is to inform the surgeon about the client's concern. This action ensures that the surgeon is aware of the client's specific request or concern related to the procedure. By directly involving the surgeon, the client's preferences or needs can be addressed effectively, potentially avoiding any misunderstanding or dissatisfaction. Choice A has been corrected to 'Notify the surgeon of the client’s concern' as the operating room staff may not have the authority to make changes to the permit. Having the client sign a new surgical permit (Choice B) may not be necessary if the concern can be addressed by informing the surgeon, making Choice B less efficient. Adding the client’s concern to the permit (Choice C) without consulting the surgeon may not align with the standard procedure and could lead to confusion or legal issues if the surgeon is not aware of the client’s specific requests.

3. Why should a client with an ileal conduit be instructed to empty the collection device frequently?

• A. Force urine to back up into the kidneys.
• B. Suppress production of urine.
• C. Cause the device to pull away from the skin.
• D. Tear the ileal conduit

Correct answer: C

Rationale: A full urine collection bag can cause the device to pull away from the skin, leading to potential leakage and skin irritation. Choice A is incorrect because a full urine collection bag does not force urine to back up into the kidneys. Choice B is incorrect as a full collection bag does not suppress the production of urine. Choice D is incorrect as a full collection bag is unlikely to tear the ileal conduit.

4. The nurse is teaching an elderly client how to use MDIs (multi-dose inhalers). The nurse is concerned that the client is unable to coordinate the release of the medication with the inhalation phase. What is the nurse's best recommendation to improve the delivery of the medication?

• A. Nebulized treatments for home care
• B. Adding a spacer device to the MDI canister
• C. Asking a family member to assist the client with the MDI
• D. Requesting a visiting nurse to follow the client at home

Correct answer: B

Rationale: Adding a spacer device to the MDI canister is the best recommendation in this scenario. The spacer device helps to improve coordination and medication delivery by allowing the client more time to inhale the medication effectively. Nebulized treatments for home care (Choice A) involve a different delivery method and are not directly related to improving coordination with MDIs. Asking a family member to assist (Choice C) may not address the core issue of coordination between releasing the medication and inhalation. Requesting a visiting nurse (Choice D) may not be necessary if the client can improve coordination with the spacer device.

5. A nurse is caring for a client who has a surgical wound. Which of the following laboratory values places the client at risk for poor wound healing?

• A. Serum albumin 3 g/dL
• B. Total lymphocyte count 2400/mm3
• C. HCT 42%
• D. HGB 16 g/dL

Correct answer: A

Rationale: The correct answer is A: Serum albumin 3 g/dL. Low levels of serum albumin indicate poor nutritional status and can impair wound healing. Total lymphocyte count, HCT, and HGB levels are not directly related to wound healing and do not pose a significant risk for poor wound healing in this context. Total lymphocyte count reflects the immune status, HCT measures the percentage of red blood cells in blood, and HGB measures the amount of hemoglobin in blood.

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