Nursing Elites

1. An assistive personnel tells the nurse, 'I am unable to find a large blood pressure cuff for a client who is obese. Can I just use the regular cuff if I can get it to stay on?' The nurse replies that taking the blood pressure of a morbidly obese client with a regular blood pressure cuff will result in a reading that is:

• A. Low
• B. High
• C. Inaccurate
• D. Unaffected

Correct answer: B

Rationale: Using a regular blood pressure cuff on a morbidly obese client will lead to a falsely high blood pressure reading. This occurs because the cuff is not appropriately sized for the client's arm circumference, resulting in increased pressure on the artery and an inaccurate high reading. Choice A is incorrect because the reading will be falsely high, not low. Choice C is incorrect as the reading will not be accurate with an incorrectly sized cuff. Choice D is incorrect because the reading will be affected by using the wrong cuff size.

2. A client is 1-day postoperative and reports a pain level of 10 on a scale of 0 to 10. After reviewing the client’s medication administration record, which of the following medications should be administered?

• A. Meperidine 75 mg IM
• B. Fentanyl 50 mcg/hr transdermal patch
• C. Morphine 2 mg IV
• D. Oxycodone 10 mg PO

Correct answer: C

Rationale: Morphine IV is the most appropriate choice for severe postoperative pain due to its rapid onset and effectiveness. Meperidine is not preferred due to its potential side effects, and fentanyl patches are typically used for chronic pain, not acute postoperative pain. Oxycodone taken orally is not ideal for providing immediate relief in this situation.

3. A client is being taught about dietary management of hypercholesterolemia. Which of the following foods should be suggested to add to the diet?

• A. Avocados
• B. Fried chicken
• C. Whole milk
• D. Bacon

Correct answer: A

Rationale: Avocados are a good choice to suggest adding to the diet of a client with hypercholesterolemia because they are high in healthy fats, particularly monounsaturated fats, which can help manage cholesterol levels. On the other hand, fried chicken, whole milk, and bacon are high in saturated fats and cholesterol, which should be limited in a diet aimed at managing hypercholesterolemia. Therefore, choices B, C, and D are incorrect.

4. A client postoperative expresses pain during dressing changes. What should the nurse prioritize?

• A. Administer pain medication 45 minutes before changing the client’s dressing.
• B. Change the dressing less frequently.
• C. Apply a topical anesthetic before removing the dressing.
• D. Use a non-adherent dressing to reduce pain.

Correct answer: A

Rationale: Administering pain medication before changing the dressing is the priority action as it will help alleviate the client's pain and improve comfort. Choice B, changing the dressing less frequently, may hinder proper wound care and healing. Applying a topical anesthetic (choice C) might offer some relief but systemic pain medication is more effective. Using a non-adherent dressing (choice D) can reduce pain during dressing changes, but addressing immediate pain with medication is the most appropriate intervention in this case.

5. A client has C-diff infection. Which of the following actions should the nurse take?

• A. Give the client chlorhexidine gluconate for hand hygiene.
• B. Remove the protective gown first when exiting the client's room.
• C. Use alcohol-based hand rub when caring for the client.
• D. Initiate contact precautions when providing client care.

Correct answer: D

Rationale: The correct answer is to initiate contact precautions when providing client care. C-diff (Clostridium difficile) is highly contagious, and contact precautions are necessary to prevent its spread. Giving the client chlorhexidine gluconate for hand hygiene (Choice A) is not specific to managing C-diff. Removing the protective gown first when exiting the client's room (Choice B) may increase the risk of contaminating oneself and the environment. Using alcohol-based hand rub when caring for the client (Choice C) is not sufficient to prevent the transmission of C-diff, as soap and water are more effective against this particular pathogen.

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