Nursing Elites

1. A guardian reports that a 4-year-old child is waking up with nightmares. Which of the following interventions should the nurse suggest?

• A. Offer the child a large snack before bedtime.
• B. Allow the child to watch an extra 30 minutes of TV in the evening.
• C. Have the child go to bed at a consistent time every day.
• D. Increase physical activity before bedtime.

Correct answer: C

Rationale: The correct answer is to have the child go to bed at a consistent time every day. Consistent bedtime routines can help reduce nightmares by providing the child with a sense of security and stability. Offering a large snack before bedtime or allowing extra TV time may disrupt sleep patterns and lead to nightmares. Increasing physical activity before bedtime could have the opposite effect and make it harder for the child to fall asleep.

2. Three days following surgery, a male client observes his colostomy for the first time. He becomes quite upset and tells the LPN that it is much bigger than he expected. What is the best response by the nurse?

• A. Reassure the client that he will become accustomed to the stoma's appearance in time.
• B. Instruct the client that the stoma will become smaller when the initial swelling diminishes.
• C. Offer to contact a member of the local ostomy support group to help him with his concerns.
• D. Encourage the client to handle the stoma equipment to gain confidence with the procedure.

Correct answer: B

Rationale: The correct response is to instruct the client that the stoma will become smaller when the initial swelling diminishes. This explanation helps reassure the client about the temporary appearance of the stoma. Choice A is incorrect because simply reassuring the client that he will become accustomed to the stoma's appearance does not address the immediate concern about the stoma size. Choice C is incorrect because offering to contact a support group does not directly address the client's current distress about the stoma size. Choice D is incorrect because encouraging the client to handle stoma equipment does not directly address the client's concern about the stoma size and may not be appropriate at this time.

3. A nurse is caring for a client who is unstable and has vital signs measured every 15 minutes by an electronic blood pressure machine. The nurse notices the machine begins to measure the blood pressure at varied intervals and the readings are inconsistent. Which of the following actions should the nurse take?

• A. Discontinue the machine and measure the blood pressure manually every 15 minutes.
• B. Adjust the machine settings.
• C. Clean the machine to ensure accuracy.
• D. Increase the frequency of the readings.

Correct answer: B

Rationale: In this scenario, the nurse should adjust the machine settings. If the electronic blood pressure machine is providing varied intervals and inconsistent readings, it indicates a potential malfunction. Changing the settings may help correct the issue and ensure accurate measurements. Discontinuing the machine and measuring manually every 15 minutes (Choice A) may be time-consuming and impractical. Cleaning the machine (Choice C) is important for routine maintenance but may not address the current issue of varied intervals and inconsistent readings. Increasing the frequency of the readings (Choice D) does not address the problem of inaccurate measurements caused by the malfunctioning machine.

4. When should discharge planning for a client experiencing an exacerbation of heart failure be initiated?

• A. During the admission process
• B. After the client is stabilized
• C. When the client expresses readiness to go home
• D. Just before the expected discharge date

Correct answer: A

Rationale: Discharge planning for a client with an exacerbation of heart failure should begin during the admission process. Initiating discharge planning early ensures a smooth transition and continuity of care for the client. Option B, after the client is stabilized, is not ideal because planning should start early to address potential barriers to discharge. Option C, when the client expresses readiness to go home, may be too late as discharge planning is a proactive process. Option D, just before the expected discharge date, does not allow enough time for comprehensive planning and coordination of post-discharge care needs.

5. A healthcare provider has inserted an indwelling catheter for a male patient. Where should the healthcare provider tape the catheter to prevent pressure on the client's urethra at the penoscrotal junction?

• A. Lower abdomen
• B. Upper thigh
• C. Penoscrotal junction
• D. Mid-abdomen

Correct answer: A

Rationale: Taping the catheter to the lower abdomen is the correct placement to prevent pressure on the urethra at the penoscrotal junction. Securing the catheter at the lower abdomen helps in reducing discomfort and minimizes the risk of trauma to the urethra. Placing the catheter on the upper thigh or penoscrotal junction can lead to tension on the catheter and potential discomfort for the patient. Taping the catheter to the mid-abdomen is not recommended as it does not provide the necessary support to prevent pressure on the urethra at the penoscrotal junction.

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