Nursing Elites

1. A healthcare professional is reviewing the medical history of a client with dementia. Which of the following findings should be addressed immediately?

• A. Frequent episodes of wandering at night
• B. Restlessness and agitation
• C. Mild confusion during the day
• D. Incontinence

Correct answer: B

Rationale: Restlessness and agitation in clients with dementia should be addressed immediately as they can indicate underlying causes such as pain, discomfort, or unmet needs. Addressing these symptoms promptly can help prevent the escalation of behavioral issues and improve the client's quality of life. While frequent episodes of wandering at night, mild confusion during the day, and incontinence are also important issues to address in clients with dementia, restlessness and agitation usually require immediate attention to ensure the safety and well-being of the client.

2. A nurse is preparing to administer a client's morning medications. Which of the following actions should the nurse take to verify the client's identity?

• A. Ask the client's full name
• B. Scan the client's facility identification band
• C. Call the client's name
• D. Verify with a second nurse

Correct answer: B

Rationale: The correct action to verify a client's identity when administering medications is to scan the client's facility identification band. This method ensures accuracy and helps prevent medication errors. Asking the client's full name (Choice A) may not be reliable as names can be similar, leading to confusion. Calling the client's name (Choice C) may not be effective if there are multiple clients with the same name in the facility. Verifying with a second nurse (Choice D) is an important safety measure for certain tasks but is not specifically for verifying a client's identity.

3. A client at 20 weeks of gestation is being taught by a nurse about an alpha-fetoprotein (AFP) test. Which of the following information should the nurse include?

• A. This test is used to confirm pregnancy
• B. This test is used to detect neural tube defects
• C. This test will determine the baby's lung maturity
• D. This test will check for gestational diabetes

Correct answer: B

Rationale: The correct answer is B: 'This test is used to detect neural tube defects.' An alpha-fetoprotein test is essential for screening neural tube defects in the fetus, not for confirming pregnancy, determining lung maturity, or checking for gestational diabetes. Detecting neural tube defects is crucial for early intervention and management of potential health issues in the baby.

4. A client with acute diverticulitis is receiving teaching from a nurse. Which of the following statements by the client indicates an understanding of the instructions?

• A. I will avoid eating fiber until this condition resolves
• B. I will take a laxative daily
• C. I will receive the nutrients I need through my IV fluids
• D. I will eat only solid foods

Correct answer: A

Rationale: The correct answer is A. During acute diverticulitis, avoiding fiber is essential as it helps reduce irritation of the intestines. Choice B is incorrect because taking a laxative daily can exacerbate diverticulitis. Choice C is incorrect as IV fluids mainly provide hydration and electrolytes, not all essential nutrients. Choice D is incorrect because during acute diverticulitis, a low-fiber or liquid diet is typically recommended to rest the bowel.

5. What is the first step in assessing a patient with suspected stroke?

• A. Check for facial droop
• B. Assess speech clarity
• C. Perform a neurological assessment
• D. Call for emergency assistance

Correct answer: D

Rationale: The correct answer is to call for emergency assistance (Option D) when assessing a patient with suspected stroke. Time is crucial in stroke management, and activating emergency services promptly can ensure timely access to specialized care such as stroke units and treatments like thrombolytic therapy. Checking for facial droop (Option A), assessing speech clarity (Option B), and performing a neurological assessment (Option C) are important steps in evaluating a stroke but should follow the immediate action of calling for emergency assistance. These initial assessments can help confirm the suspicion of a stroke and provide valuable information to healthcare providers when they arrive. However, the priority is to ensure the patient receives appropriate care without delay by activating emergency services.

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