Nursing Elites

1. A nurse is providing teaching to a client who has type 1 diabetes mellitus about foot care. Which of the following instructions should the nurse include?

• A. Soak your feet in warm water daily.
• B. Wear cotton socks.
• C. Trim your toenails straight across.
• D. Apply lotion to your feet after bathing.

Correct answer: C

Rationale: The correct answer is C: 'Trim your toenails straight across.' Trimming toenails straight across helps prevent ingrown toenails, which is important for clients with diabetes to prevent infections. Choice A is incorrect because soaking feet in warm water can lead to skin breakdown and infections. Choice B is incorrect as cotton socks can retain moisture, increasing the risk of fungal infections. Choice D is also incorrect as applying lotion between the toes can create a moist environment, increasing the risk of infections.

2. A nurse is preparing to insert an indwelling urinary catheter for a female client. Which of the following actions should the nurse take?

• A. Perform perineal care before the procedure.
• B. Apply sterile gloves before cleansing the perineal area.
• C. Place the client in a supine position.
• D. Lubricate the catheter with alcohol-based gel.

Correct answer: B

Rationale: Before inserting an indwelling urinary catheter for a female client, the nurse should apply sterile gloves before cleansing the perineal area to prevent infection. Performing perineal care before the procedure is incorrect as it should be done after catheter insertion. Placing the client in a side-lying position is not necessary for this procedure. Lubricating the catheter with petroleum jelly is not recommended as it can damage the catheter; using a water-soluble lubricant is preferred.

3. How should a healthcare provider monitor a patient with suspected deep vein thrombosis (DVT)?

• A. Monitor for leg swelling
• B. Encourage ambulation
• C. Check for redness
• D. Monitor oxygen saturation

Correct answer: A

Rationale: The correct way for a healthcare provider to monitor a patient with suspected deep vein thrombosis (DVT) is to check for leg swelling. Leg swelling is a common symptom of DVT and monitoring for this sign is crucial for early detection and intervention. Encouraging ambulation may be beneficial for preventing DVT but is not the recommended method for monitoring an existing condition. Checking for redness may be useful in cases of superficial thrombophlebitis but is not specific to DVT. Monitoring oxygen saturation is more relevant for respiratory or cardiovascular conditions, not for DVT.

4. A client who is postoperative following a colon resection reports pain. Which of the following actions should the nurse take?

• A. Assist the client in changing positions in bed
• B. Administer a PRN dose of morphine
• C. Encourage the client to use relaxation techniques
• D. Offer the client a back massage

Correct answer: B

Rationale: Administering a PRN dose of morphine is the most appropriate action to manage postoperative pain in a client following a colon resection. Morphine is a potent analgesic commonly used to relieve moderate to severe pain, especially in postoperative settings. While assisting the client to change positions in bed, encouraging relaxation techniques, and offering a back massage can provide comfort and support, they may not be sufficient in managing the pain following a major surgical procedure like a colon resection. Therefore, the priority intervention for acute postoperative pain control in this scenario is to administer medication like morphine.

5. A nurse is assessing a client who is in active labor. The FHR baseline has been 100/min for the past 15 minutes. What condition should the nurse suspect?

• A. Maternal fever.
• B. Fetal anemia.
• C. Maternal hypoglycemia.
• D. Chorioamnionitis.

Correct answer: C

Rationale: In this scenario, the FHR baseline of 100/min for the past 15 minutes indicates fetal bradycardia, which can be caused by maternal hypoglycemia. Maternal hypoglycemia can lead to decreased oxygen supply to the fetus, resulting in fetal bradycardia. Maternal fever (Choice A) typically presents with tachycardia in the fetus rather than bradycardia. Fetal anemia (Choice B) is more likely to manifest as tachycardia due to compensation for decreased oxygen delivery. Chorioamnionitis (Choice D) may lead to fetal tachycardia as a sign of fetal distress, not bradycardia.

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