Nursing Elites

1. After delegating care to an unlicensed assistive personnel (UAP) for a client who is prescribed habit training to manage incontinence, a nurse evaluates the UAP’s understanding. Which action indicates the UAP needs additional teaching?

• A. Toileting the client after breakfast
• B. Changing the client’s incontinence brief when wet
• C. Encouraging the client to drink fluids
• D. Recording the client’s incontinence episodes

Correct answer: B

Rationale: The correct action that indicates the UAP needs additional teaching is choice B, 'Changing the client’s incontinence brief when wet.' Habit training is a technique used to manage incontinence, and it is undermined by the use of absorbent incontinence briefs or pads. The nurse should re-educate the UAP on the technique of habit training, which involves scheduled toileting and promoting bladder control. Choices A, C, and D are appropriate actions that support the client’s care: toileting the client after meals, encouraging fluid intake, and documenting incontinence episodes are all important aspects of managing incontinence and monitoring the client's condition.

2. A postmenopausal client asks the nurse why she is experiencing discomfort during intercourse. What response is best for the nurse to provide?

• A. Estrogen deficiency causes the vaginal tissues to become dry and thinner.
• B. Infrequent intercourse results in the vaginal tissues losing their elasticity.
• C. Dehydration from inadequate fluid intake causes vulva tissue dryness.
• D. Lack of adequate stimulation is the most common reason for dyspareunia.

Correct answer: A

Rationale: Estrogen deficiency in postmenopausal clients leads to a decrease in the moisture-secreting capacity of vaginal cells. This results in vaginal tissues becoming thinner, drier, and smoother, which reduces vaginal stretching and contributes to discomfort during intercourse. Choice B is incorrect because the primary reason for discomfort is not infrequent intercourse but rather physiological changes due to estrogen deficiency. Choice C is incorrect as dehydration may cause dryness but is not the primary reason for discomfort in this scenario. Choice D is incorrect as lack of stimulation is not the most common reason for dyspareunia in postmenopausal clients; estrogen deficiency is the key factor.

3. A client has driven himself to the emergency department. He is 50 years old, has a history of hypertension, and informs the nurse that his father died from a heart attack at age 60. The client has indigestion. The nurse connects him to an electrocardiogram monitor and begins administering oxygen at 2 L/min via nasal cannula. What should the nurse do next?

• A. Call for the physician.
• B. Start an IV infusion.
• C. Obtain a portable chest radiograph.
• D. Draw blood for laboratory studies.

Correct answer: B

Rationale: In a client presenting with possible myocardial infarction who is receiving oxygen therapy and cardiac monitoring, the next priority action is to establish IV access by starting an IV infusion. This allows for prompt administration of medications and fluids as needed in the management of acute coronary syndromes. Calling the physician (Choice A) may be necessary but is not the immediate next step. Obtaining a portable chest radiograph (Choice C) may help in further assessment but is not as crucial as establishing IV access. Drawing blood for laboratory studies (Choice D) is important for diagnostic purposes but is not as urgent compared to starting an IV infusion in the setting of a potential myocardial infarction.

4. The client has been managing angina episodes with nitroglycerin. Which of the following indicates the drug is effective?

• A. Decreased chest pain.
• B. Increased blood pressure.
• C. Decreased blood pressure.
• D. Decreased heart rate.

Correct answer: A

Rationale: The correct answer is A: Decreased chest pain. Nitroglycerin is a vasodilator that works by decreasing myocardial oxygen consumption, which helps to reduce chest pain caused by angina. Therefore, a reduction in chest pain is a positive indicator of the drug's effectiveness. Choices B, C, and D are incorrect because nitroglycerin does not typically increase blood pressure or heart rate; instead, it often causes a decrease in blood pressure due to vasodilation and may cause a reflex tachycardia (increased heart rate) as a compensatory response to lowered blood pressure.

5. When assessing the lower extremities of a client with peripheral vascular disease (PVD), the nurse notes bilateral ankle edema. The edema is related to:

• A. Competent venous valves.
• B. Decreased blood volume.
• C. Increase in muscular activity.
• D. Increased venous pressure.

Correct answer: D

Rationale: The correct answer is 'Increased venous pressure.' In peripheral vascular disease (PVD), impaired blood flow leads to increased venous pressure in the lower extremities, causing fluid to leak out of the blood vessels and accumulate as edema. Choice A, 'Competent venous valves,' is incorrect because in PVD, the venous valves may be incompetent, contributing to venous pooling and edema. Choice B, 'Decreased blood volume,' is incorrect as PVD is associated with impaired blood flow rather than reduced blood volume. Choice C, 'Increase in muscular activity,' is incorrect as it does not directly relate to the development of edema in PVD.

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