Nursing Elites

1. When preparing to examine a client’s skin using a Wood light, what should the nurse do to facilitate this procedure?

• A. Darken the examining room
• B. Administer a local anesthetic
• C. Obtain a signed informed consent
• D. Shave the skin and scrub it with povidone-iodine (Betadine)

Correct answer: A

Rationale: When using a Wood light to examine the skin, the nurse should darken the examining room. This is necessary because the Wood light emits long-wavelength UV light, which is better visualized in a darkened environment. Administering a local anesthetic (Choice B) is not needed for this procedure. Obtaining a signed informed consent (Choice C) is not directly related to using a Wood light for skin examination. Shaving the skin and scrubbing it with povidone-iodine (Betadine) (Choice D) is not required and may not be appropriate for this type of skin examination.

2. Upon admission, a 77-year-old female client presents with confusion, loss of appetite, nausea, vomiting, and headache, with a pulse rate of 43 beats per minute. Which question should the nurse prioritize asking the client or her family?

• A. Does the client have her own teeth or dentures?
• B. Does the client take aspirin, and if so, what is the dosage?
• C. Does the client take nitroglycerin?
• D. Does the client take digitalis?

Correct answer: D

Rationale: The correct answer is D. The client's symptoms suggest digitalis toxicity, a potentially life-threatening condition that requires immediate attention. Digitalis toxicity can present with symptoms such as anorexia, nausea, vomiting, headache, and bradycardia (low pulse rate). Given the client's presentation, it is crucial to assess for digitalis use as elderly individuals are more susceptible to this type of intoxication. Choices A, B, and C are important aspects to consider during the assessment, but in this scenario, the priority lies in identifying and addressing the potential digitalis toxicity due to the severity of symptoms and the need for prompt intervention.

3. After educating a client with a history of renal calculi, the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the teaching?

• A. I should drink at least 3 liters of fluid every day.
• B. I will eliminate all dairy or sources of calcium from my diet.
• C. Aspirin and aspirin-containing products can lead to stones.
• D. The doctor can give me antibiotics at the first sign of a stone.

Correct answer: A

Rationale: To prevent the formation of renal calculi, it is essential to maintain adequate hydration as dehydration can contribute to the precipitation of minerals leading to stone formation. Therefore, the correct statement indicating understanding of the teaching is choice A. Increasing fluid intake helps dilute urine and reduces the risk of stone formation. Eliminating all sources of calcium is not recommended as calcium is essential for various bodily functions and eliminating it can lead to other health issues. Aspirin and aspirin-containing products do not directly cause kidney stones. Antibiotics are not used to prevent or treat renal calculi, as they are not caused by bacterial infections.

4. The client with chronic renal failure who is on a low-sodium diet should avoid which of the following foods?

• A. Fresh fruits.
• B. Canned soups.
• C. Lean meats.
• D. Whole grain bread.

Correct answer: B

Rationale: Canned soups are high in sodium, which can lead to fluid retention and hypertension in clients with chronic renal failure who are on a low-sodium diet. Fresh fruits, lean meats, and whole grain bread are generally lower in sodium and can be included in a low-sodium diet. Lean meats provide essential protein, fresh fruits offer vitamins and minerals, and whole grain bread provides fiber, making them suitable choices for individuals with chronic renal failure.

5. Which instruction should be included in the discharge teaching plan for a client who underwent cataract extraction today?

• A. Use a metal eye shield on the operative eye during the day.
• B. Administer eye ointment before applying eye drops.
• C. Sexual activities may be resumed after returning home.
• D. Light housekeeping is safe to do, but avoid heavy lifting.

Correct answer: D

Rationale: The correct instruction to include in the discharge teaching plan for a client who underwent cataract extraction is to advise them that light housekeeping is safe to do, but they should avoid heavy lifting. Heavy lifting can strain the surgical site and potentially lead to complications. Choice A is incorrect as a metal eye shield is usually recommended during sleep, not during the day. Choice B is incorrect because eye ointment should typically be administered after applying eye drops to prevent dilution of the medication. Choice C is incorrect as sexual activities should usually be avoided for a specific period post-surgery as advised by the healthcare provider.

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