Nursing Elites

1. A client is being taught how to care for their tracheostomy at home. Which of the following instructions should the nurse include in the teaching?

• A. Use tracheostomy covers when outdoors.
• B. Clean the tracheostomy site with hydrogen peroxide daily.
• C. Change the tracheostomy tube weekly.
• D. Apply ointment around the tracheostomy site.

Correct answer: A

Rationale: The correct instruction is to use tracheostomy covers when outdoors. Tracheostomy covers serve to protect the airway from environmental contaminants, reducing the risk of infection. Choice B is incorrect because hydrogen peroxide can be irritating to the skin and is not recommended for cleaning the tracheostomy site. Choice C is incorrect as tracheostomy tubes should not be routinely changed weekly unless there is a specific medical indication. Changing it without a need can introduce infection or damage the stoma. Choice D is incorrect as applying ointment around the tracheostomy site can lead to occlusion of the stoma and interfere with breathing.

2. A client with Parkinson's disease is being discharged. Which statement by the client indicates a need for further teaching?

• A. I will take my medication at the same time every day.
• B. I will increase my fiber intake to prevent constipation.
• C. I will perform range of motion exercises to maintain mobility.
• D. I will stop taking my medication if I feel better.

Correct answer: D

Rationale: The correct answer is D. Patients with Parkinson's disease should not stop taking their medication if they feel better, as doing so can worsen symptoms. It is crucial for patients to continue their prescribed medication regimen as directed by their healthcare provider. Choices A, B, and C are all appropriate actions that promote the well-being of a client with Parkinson's disease. Choice A emphasizes medication adherence, which is vital for symptom management. Choice B addresses a common issue in Parkinson's patients and shows an understanding of the importance of dietary management. Choice C highlights the significance of physical activity in maintaining mobility, which is essential for overall quality of life in Parkinson's disease.

3. The nurse is caring for a patient diagnosed with diabetes. Which task will the nurse assign to the nursing assistive personnel?

• A. Providing nail care
• B. Teaching foot care
• C. Making the patient's bed
• D. Determining aspiration risk

Correct answer: C

Rationale: The correct answer is making the patient's bed. Delegating bed-making tasks to nursing assistive personnel is appropriate as it falls within their scope of practice and helps free up the nurse's time to focus on tasks that require their specialized skills and knowledge. Providing nail care and teaching foot care involve direct patient care and education, which should be performed by licensed nursing staff. Determining aspiration risk requires critical thinking and clinical judgment, making it a responsibility of the nurse.

4. A provider prescribes cold application for a client who reports ankle joint stiffness. Which of the following assessment findings should the nurse identify as a contraindication to the application of cold?

• A. Capillary refill of 4 seconds
• B. 7.5 cm (3 in) diameter bruise on the ankle
• C. Warts on the affected ankle
• D. 2+ pitting edema

Correct answer: A

Rationale: The correct answer is A. Capillary refill of 4 seconds indicates poor circulation, which is a contraindication to cold application as it could worsen the condition by further reducing blood flow. Choice B, a 7.5 cm (3 in) diameter bruise on the ankle, does not directly contraindicate cold application but may need evaluation for possible underlying injuries. Choice C, warts on the affected ankle, do not necessarily contraindicate cold application. Choice D, 2+ pitting edema, is not a direct contraindication to cold application but may need to be addressed separately.

5. Upon completing the admission documents, the nurse learns that the 87-year-old client does not have an advance directive. What action should the nurse take?

• A. Record the lack of advance directive on the chart
• B. Give information about advance directives
• C. Assume that the client wishes a full code
• D. Refer this issue to the unit secretary

Correct answer: B

Rationale: The correct action for the nurse to take is to give information about advance directives to the client. By providing this information, the nurse empowers the client to make an informed decision about their care preferences. Choice A is incorrect because simply recording the lack of advance directive does not address the client's need for information. Choice C is incorrect because assuming the client wishes a full code without discussing it with them is not appropriate and may not align with the client's wishes. Choice D is incorrect as the nurse should directly address the issue with the client rather than involving another staff member.

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