Nursing Elites

1. A client who underwent a total hip replacement is receiving discharge teaching from a nurse. Which instruction should the nurse include?

• A. Avoid crossing your legs at the knees.
• B. Sit only in low chairs for comfort.
• C. Bend at the waist to pick up objects.
• D. Sleep on the affected side to prevent discomfort.

Correct answer: A

Rationale: The correct instruction the nurse should include is to avoid crossing the legs at the knees. This advice helps prevent dislocation of the new hip joint, which is a common concern after a total hip replacement surgery. Crossing the legs can place stress on the hip joint and increase the risk of dislocation. It is important for the client to follow this precaution to promote proper healing and reduce complications postoperatively.

2. What action should the nurse take to prevent tracheal tissue damage in a client with a tracheostomy?

• A. Secure the tracheostomy ties firmly.
• B. Change the tracheostomy tube daily.
• C. Use the minimal leak technique when inflating the cuff.
• D. Clean the stoma with hydrogen peroxide.

Correct answer: C

Rationale: To prevent tracheal tissue damage in a client with a tracheostomy, the nurse should use the minimal leak technique when inflating the cuff. This method helps avoid excessive pressure on the tracheal tissue, thereby reducing the risk of damage. Choice A is incorrect because securing the tracheostomy ties too tightly can cause pressure and tissue damage. Choice B is incorrect as changing the tracheostomy tube daily is not necessary unless there is a specific clinical indication. Choice D is incorrect as cleaning the stoma with hydrogen peroxide can irritate the skin and mucous membranes, potentially leading to damage.

3. During an admission physical assessment, the nurse is examining a newborn who is small for gestational age (SGA). Which finding should the nurse report immediately to the pediatric healthcare provider?

• A. Heel stick glucose of 65 mg/dL.
• B. Head circumference of 35 cm (14 inches).
• C. Widened, tense, bulging fontanel.
• D. High-pitched shrill cry.

Correct answer: C

Rationale: A widened, tense, bulging fontanel is a critical finding in a newborn as it can indicate increased intracranial pressure. This condition requires immediate attention and intervention to prevent further complications. Monitoring fontanel status is crucial in assessing the newborn's neurological well-being and ensuring early detection of potential issues.

4. The sister of a patient diagnosed with BRCA gene-related breast cancer asks the nurse, 'Do you think I should be tested for the gene?' Which response by the nurse is most appropriate?

• A. In most cases, breast cancer is not caused by the BRCA gene.
• B. It depends on how you will feel if the test is positive for the BRCA gene.
• C. There are many things to consider before deciding to have genetic testing.
• D. You should decide first whether you are willing to have a bilateral mastectomy.

Correct answer: C

Rationale: The most appropriate response by the nurse is C: 'There are many things to consider before deciding to have genetic testing.' Genetic testing for BRCA gene mutations is a complex decision that involves various factors such as emotional readiness, potential impact on insurance and employability, and the implications of test results. Option A is incorrect because although most breast cancers are not related to BRCA gene mutations, individuals with these mutations have a significantly higher risk. Option B is not ideal as it oversimplifies the decision-making process by focusing solely on emotional aspects. Option D is incorrect as it implies a predetermined course of action (mastectomy) before even undergoing genetic testing, which is not appropriate.

5. The healthcare provider is assessing a client with chronic obstructive pulmonary disease (COPD). Which finding should the provider expect?

• A. Increased anteroposterior chest diameter.
• B. Decreased respiratory rate.
• C. Dull percussion sounds over the lungs.
• D. Hyperresonance on chest percussion.

Correct answer: A

Rationale: The correct answer is A: Increased anteroposterior chest diameter. The increased anteroposterior chest diameter, often referred to as a barrel chest, is a common finding in clients with COPD due to hyperinflation of the lungs. This occurs because of the loss of lung elasticity and air trapping, leading to a more rounded chest shape. Choices B, C, and D are incorrect. Decreased respiratory rate is not typically associated with COPD; instead, an increased respiratory rate may be seen due to the body's compensatory mechanisms. Dull percussion sounds and hyperresonance on chest percussion are not characteristic findings in COPD. Dull percussion sounds may be indicative of consolidation or pleural effusion, while hyperresonance is more commonly associated with conditions like emphysema.

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