Nursing Elites

1. A nurse is preparing to perform a sterile dressing change for a client who has a surgical wound. Which of the following actions should the nurse take to prevent contamination during the dressing change?

• A. Use sterile gloves only as necessary
• B. Restart the procedure if the sterile solution splashes onto the sterile field while pouring the solution into the dressing tray
• C. Keep the dressing tray on a nearby surface
• D. Avoid speaking during the procedure

Correct answer: B

Rationale: The correct action to prevent contamination during a sterile dressing change is to restart the procedure if the sterile solution splashes onto the sterile field while pouring the solution into the dressing tray. Any contact with the sterile field by non-sterile items makes the field contaminated and requires restarting the procedure to maintain sterility. Choice A is incorrect because sterile gloves should always be used during a sterile procedure to prevent contamination. Choice C is incorrect as the dressing tray should be placed on a sterile surface, not on the client's bed, to maintain sterility. Choice D is also incorrect as talking during the procedure does not necessarily lead to contamination if proper aseptic technique is maintained.

2. A client with GERD is receiving discharge instructions from a nurse. Which statement by the client indicates an understanding of the teaching?

• A. “I should take my medicine with orange juice.”
• B. “Having a bedtime snack will prevent heartburn.”
• C. “I will lie down after meals.”
• D. “I will limit activities that require bending at the waist.”

Correct answer: D

Rationale: The correct answer is D. Limiting activities that require bending at the waist can help prevent episodes of reflux in clients with GERD. Choices A, B, and C are incorrect. Taking medicine with orange juice may not be appropriate as citrus juices can aggravate GERD. Having a bedtime snack can exacerbate heartburn by increasing stomach acid production, and lying down after meals can worsen symptoms of GERD by allowing stomach acid to flow back into the esophagus.

3. A nurse is caring for the mother of an adolescent who was killed in a motor-vehicle crash after a school event. The mother states, 'I never should have let him take the car. It's all my fault!' Which of the following responses by the nurse is appropriate?

• A. You had no way of knowing this would happen.
• B. Most parents blame themselves when losing a child.
• C. Tell me why you feel this is your fault.
• D. You appear to be feeling overwhelmed.

Correct answer: C

Rationale: Choice C is the most appropriate response because it encourages the mother to express her feelings and explore the reasons behind her guilt. This approach allows the mother to process her emotions effectively and address her grief. Choices A and B do not directly address the mother's feelings of guilt and may not help her work through her emotions. Choice D acknowledges the mother's emotional state but does not delve into the underlying issues causing her guilt and grief.

4. A nurse is completing an admission assessment for a client who has hearing loss. What action should the nurse take?

• A. Speak loudly to the client
• B. Use written communication to assist with communication
• C. Avoid eye contact while speaking
• D. Use sign language without an interpreter

Correct answer: B

Rationale: The correct action for the nurse to take when assessing a client with hearing loss is to use written communication. This method helps ensure effective communication and that the client understands the information being conveyed. Speaking loudly may not be helpful and can be perceived as rude. Avoiding eye contact can hinder communication and appear disrespectful. Using sign language without an interpreter may not be appropriate if the client does not understand sign language.

5. A healthcare provider is reviewing laboratory values for a client who reports fatigue and cold intolerance. The client has an increased thyroid-stimulating hormone (TSH) level and a decreased total T3 and T4 level. The healthcare provider should anticipate a prescription for which of the following medications?

• A. Methimazole
• B. Somatropin
• C. Levothyroxine
• D. Propylthiouracil

Correct answer: C

Rationale: The client’s symptoms and lab results indicate hypothyroidism, and levothyroxine is the standard treatment to replace the deficient thyroid hormones. Methimazole and propylthiouracil are used to treat hyperthyroidism by decreasing the production of thyroid hormones. Somatropin is a growth hormone used in conditions of growth hormone deficiency, not for hypothyroidism.

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