Nursing Elites

1. A post-operative client is prescribed sequential compression devices (SCDs) while on bed rest. What is the primary purpose of this device?

• A. To prevent deep vein thrombosis (DVT).
• B. To improve circulation in the legs.
• C. To prevent pressure ulcers.
• D. To alleviate post-operative pain.

Correct answer: A

Rationale: The correct answer is A: 'To prevent deep vein thrombosis (DVT).' Sequential compression devices (SCDs) are primarily used to prevent deep vein thrombosis (DVT) by promoting blood flow in the legs and reducing venous stasis, which is a common risk for post-operative clients who are on bed rest. While SCDs do improve circulation in the legs indirectly, their primary purpose is DVT prevention. Preventing pressure ulcers is typically achieved through repositioning and support surfaces, not with SCDs, making choice C incorrect. SCDs are not used to alleviate post-operative pain, so choice D is also incorrect.

2. The PN reviews a client's medication history and learns that the client takes an anticoagulant and has recently started taking phenytoin. Which instruction should the PN provide when assigning the client's morning care to a UAP?

• A. Measure the temperature every 4 hours
• B. Elevate both feet on two pillows
• C. Initiate hourly turning schedule
• D. Protect skin from injury and bruising

Correct answer: D

Rationale: The correct answer is D: Protect skin from injury and bruising. Phenytoin and anticoagulants both increase the risk of bleeding. Protecting the skin from injury and bruising is critical to prevent complications, making it important to instruct the UAP accordingly. Measuring the temperature every 4 hours (Choice A) may not be directly related to the client's medications. Elevating both feet on two pillows (Choice B) is more relevant for issues like edema. Initiating an hourly turning schedule (Choice C) is important for preventing pressure ulcers, but in this case, the priority is to prevent bleeding due to the medications.

3. Based on the computer documentation in the EMR, which action should the PN implement?

• A. Give the rubella vaccine subcutaneously
• B. Observe the mother breastfeeding her infant
• C. Call the nursery for the infant's blood type results
• D. Administer hydrocodone/acetaminophen one tablet for pain

Correct answer: A

Rationale: The rubella vaccine is crucial for preventing rubella infection, which can cause severe congenital disabilities if contracted during pregnancy. Administering the vaccine subcutaneously is the correct action based on EMR documentation. Observing breastfeeding, calling the nursery for blood type results, and administering pain medication are not indicated by the EMR documentation and are not relevant to the situation described in the question.

4. A client with a chest tube following a pneumothorax is concerned about the continuous bubbling in the water seal chamber. What should the nurse explain to the client?

• A. Continuous bubbling in the water seal chamber indicates an air leak.
• B. Continuous bubbling is normal and expected with a chest tube.
• C. Bubbling will stop when the lung has fully expanded.
• D. The nurse should notify the healthcare provider immediately.

Correct answer: A

Rationale: Continuous bubbling in the water seal chamber of a chest tube system indicates an air leak. An air leak can prevent the lung from fully re-expanding and may lead to complications like a recurrent pneumothorax. Therefore, it is crucial to investigate and address the air leak promptly. Choices B and C are incorrect because continuous bubbling is not normal and does not indicate lung expansion. Choice D is incorrect because the nurse should first assess and then report the issue to the healthcare provider.

5. Which vitamin deficiency is most associated with night blindness?

• A. Vitamin A
• B. Vitamin B12
• C. Vitamin C
• D. Vitamin D

Correct answer: A

Rationale: The correct answer is Vitamin A. Vitamin A deficiency leads to night blindness because this vitamin is crucial for the formation of rhodopsin, a photopigment in the retina. Rhodopsin is essential for vision in low-light conditions. Vitamin B12 deficiency can lead to anemia and neurological issues but is not directly related to night blindness. Vitamin C deficiency can cause scurvy, affecting connective tissues, but not night vision. Vitamin D deficiency can lead to bone disorders but is not primarily associated with night blindness.

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