Nursing Elites

1. Which of the following clients would be most appropriate for an LPN to assign to a nursing assistant?

• A. an 18-year-old client with a femur fracture who is just returning to the floor from the recovery unit
• B. an 84-year-old client 2 days post-op after knee replacement surgery who needs help ambulating
• C. a 35-year-old client who is suffering from an acute asthma attack
• D. a 20-year-old client with Cystic Fibrosis who needs an early morning sputum sample collection

Correct answer: D

Rationale: Collecting sputum samples on stable clients is within the scope of practice for an LPN. This task does not require immediate intervention or assessment by an RN or medical provider. An RN should perform the initial assessment on any client immediately post-op as it requires a higher level of assessment and monitoring. A client suffering from an acute asthma attack should be attended to by an RN or medical provider due to the potential severity and need for prompt intervention. Assigning a medically stable client who needs help ambulating to a nursing assistant is appropriate as it falls within their scope of practice and allows the LPN to focus on tasks that require their expertise.

2. When are pressure ulcers most likely to occur?

• A. when clients are left in one position in bed for extended periods of time.
• B. when clients are underweight.
• C. when clients are overweight.
• D. only in underweight and overweight clients.

Correct answer: A

Rationale: Pressure ulcers usually occur over bony prominences and are caused by decreased circulation. The client who is left in one position in bed for extended periods of time is more prone to decreased circulation to an area of the body and to acquiring a pressure ulcer. Choices B and C are incorrect as pressure ulcers are not exclusive to underweight or overweight clients. The key factor is prolonged pressure on the skin, not the weight of the client. Therefore, the correct answer is that pressure ulcers are most likely to occur when clients are immobilized in one position for extended periods of time.

3. Where do the vast majority of deaths resulting from unintentional poisoning occur?

• A. Infants
• B. Toddlers
• C. Teens
• D. Adults

Correct answer: B

Rationale: The correct answer is 'Toddlers.' Toddlers are at the highest risk of unintentional poisoning due to their natural curiosity, explorative behavior, and lack of awareness of potential dangers. Infants are typically closely monitored, teens are more aware of risks, and adults generally have better judgment and understanding of hazardous substances, making them less susceptible to unintentional poisoning. Therefore, toddlers, being inquisitive and unaware of risks, are the most vulnerable group in terms of unintentional poisoning incidents.

4. A client with a pleural drainage system to suction has gentle bubbling of the water seal. What should the nurse do?

• A. Notify the physician.
• B. Clamp the chest tube.
• C. Replace the system.
• D. Document the finding

Correct answer: D

Rationale: Gentle bubbling is a normal finding for a client with a pleural drainage system to suction, so it simply needs to be documented for monitoring purposes. If the bubbling becomes vigorous, it could indicate a leak, which would then require further investigation by the nurse. Therefore, the correct action at this point is to document the finding. Notifying the physician is not necessary for gentle bubbling as it is expected. Clamping the chest tube or replacing the system is inappropriate and could potentially harm the client as there is no indication for such actions based on the scenario provided.

5. While undergoing fetal heart monitoring, a pregnant Native-American woman requests that a medicine woman be present in the examination room. Which of the following is an appropriate response by the nurse?

• A. "I will assist you in arranging to have a medicine woman present."?
• B. "We do not allow medicine women in exam rooms."?
• C. "That does not make any difference in the outcome."?
• D. "It is old-fashioned to believe in that."?

Correct answer: A

Rationale: The correct response is to show cultural awareness and respect the client's request by offering assistance in arranging for the medicine woman to be present. This approach acknowledges the importance of cultural beliefs and practices in the client's care, fostering trust and cooperation. Choices B, C, and D are inappropriate as they dismiss or belittle the client's cultural beliefs, showing insensitivity and lack of respect, which can negatively impact the nurse-client relationship.

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