Nursing Elites

1. A client scheduled for arthroplasty expresses concern about the risk of acquiring an infection from a blood transfusion. Which of the following statements should the nurse make to the client?

• A. Donate autologous blood before the surgery
• B. Request a specific blood type from the donor
• C. Use blood from a family member
• D. Accept allogeneic blood without concerns

Correct answer: A

Rationale: The correct statement for the nurse to make to the client is to 'Donate autologous blood before the surgery.' Autologous blood donation involves collecting and storing the client's own blood for potential use during surgery, which significantly reduces the risk of transfusion-related infections. This option directly addresses the client's concern about infection risk. Requesting a specific blood type from a donor (Choice B) is not as effective in reducing infection risk compared to autologous blood donation. Using blood from a family member (Choice C) carries the risk of transfusion reactions and infections due to compatibility issues. Accepting allogeneic blood without concerns (Choice D) does not address the client's specific concern about infection risk and is not the most appropriate option in this situation.

2. A nurse on a medical-surgical unit is washing her hands prior to assisting with a surgical procedure. Which of the following actions by the nurse demonstrates proper surgical hand-washing techniques?

• A. The nurse washes with her hands held higher than her elbows.
• B. The nurse uses a brush to scrub under her nails.
• C. The nurse washes for at least 30 seconds.
• D. The nurse uses alcohol-based hand rub only.

Correct answer: A

Rationale: Proper surgical hand-washing technique involves keeping the hands higher than the elbows to prevent contamination. Washing with hands held lower than the elbows can lead to potential contamination. Using a brush to scrub under the nails is not recommended as it can cause microabrasions, increasing infection risk. While washing for at least 30 seconds is a good practice for thorough hand hygiene, hand positioning is critical during surgical hand-washing. Using alcohol-based hand rub alone is insufficient for surgical hand-washing as it may not effectively remove dirt, debris, and transient microorganisms.

3. A nurse in an emergency department is assessing a client who reports diarrhea and decreased urination for 4 days. Which of the following actions should the nurse take to assess the client's skin turgor?

• A. Grasp a skin fold on the chest under the clavicle, release it, and note whether it springs back
• B. Pinch the skin on the back of the hand and observe for elasticity
• C. Assess the skin turgor on the abdomen by pinching the skin
• D. Check the skin turgor by pressing on the forearm and observing the rebound

Correct answer: A

Rationale: To assess skin turgor, the nurse should grasp a skin fold on the chest under the clavicle, release it, and note whether it springs back. This method is preferred for older adults and in cases of significant fluid imbalance. Option B is incorrect as assessing skin turgor on the back of the hand is not the standard assessment site for skin turgor. Option C is incorrect as the abdomen is not the typical area for assessing skin turgor; the chest under the clavicle is a more accurate site. Option D is incorrect as pressing on the forearm is not the appropriate site for evaluating skin turgor; the chest under the clavicle is the recommended location for this assessment.

4. When a nurse assigned to a manipulative client for 5 days becomes aware of feelings of reluctance to interact with the client, the next action by the nurse should be to

• A. Discuss the feeling of reluctance with an objective peer or supervisor
• B. Limit contacts with the client to avoid reinforcement of manipulative behavior
• C. Confront the client about the negative effects of behaviors on other clients and staff
• D. Develop a behavior modification plan that will promote more functional behavior

Correct answer: A

Rationale: When a nurse experiences reluctance to interact with a manipulative client, it is essential to address these feelings constructively. Discussing the feeling of reluctance with an objective peer or supervisor allows the nurse to gain perspective, reflect on the situation, and develop appropriate strategies for patient care. This action promotes self-awareness, professional growth, and ensures that patient care is not compromised. Option B is incorrect because avoiding the client may not address the underlying issues and can impact the therapeutic relationship. Option C is inappropriate as confronting the client may escalate the situation and hinder effective communication. Option D is not the immediate action needed in this scenario, as it focuses on behavior modification rather than addressing the nurse's feelings of reluctance.

5. When explaining the fecal occult blood testing procedure to a client, which of the following information should be included?

• A. Eating more protein is not necessary before testing.
• B. Multiple stool specimens may be required for testing.
• C. A red color change indicates a positive test.
• D. The specimen must not be contaminated with urine.

Correct answer: D

Rationale: The correct answer is D. When performing fecal occult blood testing, it is crucial to inform the client that the specimen must not be contaminated with urine to prevent false results. Choices A and B are incorrect because eating more protein is not required before testing, and multiple stool specimens may be necessary for accurate results, respectively. Additionally, regarding choice C, a red color change, not blue, indicates a positive test result, making it an incorrect option.

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