Nursing Elites

1. All of the following statements are true about donning sterile gloves except:

• A. The first glove should be picked up by grasping the inside of the cuff.
• B. The second glove should be picked up by inserting the gloved fingers under the cuff outside the glove.
• C. The gloves should be adjusted by sliding the gloved fingers under the sterile cuff and pulling the glove over the wrist.
• D. The inside of the glove is considered sterile.

Correct answer: D

Rationale: When donning sterile gloves, it is essential to maintain sterility. The correct way to don sterile gloves includes grasping the outside of the cuff to put on the first glove and inserting the gloved fingers under the cuff outside the glove to put on the second glove. Adjustments should be made by sliding the fingers under the sterile cuff. It is crucial to remember that once the inside of the glove is touched during the donning process, it is no longer considered sterile.

2. A healthcare professional is assessing a client following a gunshot wound to the chest. For which of the following findings should the healthcare professional not monitor to detect a pneumothorax?

• A. Tachypnea
• B. Deviation of the trachea
• C. Bradycardia
• D. Pleuritic pain

Correct answer: C

Rationale: Bradycardia, which is a slow heart rate, is not typically associated with a pneumothorax. In a pneumothorax, the presence of air in the pleural space can lead to lung collapse, causing symptoms such as tachypnea (rapid breathing), deviation of the trachea, and pleuritic pain. Monitoring for bradycardia may not be as relevant in this context as it is not a typical indicator of a pneumothorax.

3. When teaching a client with tuberculosis, which statement should the nurse include?

• A. You will need to continue taking the multi-medication regimen for 4 months.
• B. You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication.
• C. You will need to remain hospitalized for treatment.
• D. You will need to wear a mask at all times.

Correct answer: B

Rationale: Monitoring the effectiveness of tuberculosis medication is crucial to ensure the treatment is working properly. Regular sputum samples help in assessing the response to the medication. This monitoring can guide adjustments in the treatment plan if needed. Options A and C are incorrect as they do not reflect essential aspects of tuberculosis treatment. Option D is not a standard recommendation for tuberculosis treatment and may lead to misconceptions.

4. When is sterile technique used?

• A. During strict isolation procedures
• B. After terminal disinfection is performed
• C. For invasive procedures
• D. When protective isolation is necessary

Correct answer: C

Rationale: Sterile technique is utilized during invasive procedures to prevent the introduction of pathogens, minimizing the risk of infections. This strict approach ensures that the procedure is performed in a sterile environment, reducing the chances of contamination and subsequent complications.

5. A client is to receive a transfusion of packed RBCs. Which of the following actions should the nurse take?

• A. Prime IV tubing with 0.9% sodium chloride
• B. Use a 24-gauge IV catheter
• C. Obtain filterless IV tubing
• D. Place blood in the warmer for 1 hr

Correct answer: A

Rationale: Prior to administering a blood transfusion, it is essential to prime the IV tubing with 0.9% sodium chloride to prevent hemolysis of the blood cells. Using a smaller gauge IV catheter (e.g., 20 or 22 gauge) is recommended for blood transfusions to prevent hemolysis. Filterless IV tubing is contraindicated for blood transfusions as it does not have a filter to trap potential blood clots or debris. Warming blood is unnecessary and could lead to the development of bacteria in the blood product. Therefore, the correct action for the nurse to take is to prime the IV tubing with 0.9% sodium chloride.

Similar Questions