Nursing Elites

1. During a home visit, the nurse observes that an elderly client has numerous bruises on her arms and appears fearful of her caregiver. What should the nurse do first?

• A. report the findings to adult protective services
• B. ask the client how she got the bruises
• C. document the observations in the client's medical record
• D. discuss the observations with the caregiver

Correct answer: B

Rationale: The initial step for the nurse should be to ask the client how she got the bruises. This approach allows the nurse to directly assess the situation, gather information from the client, and potentially uncover signs of abuse. Reporting to adult protective services should come after obtaining more details from the client to ensure appropriate action. Documenting the observations is important but should follow gathering information from the client. Discussing the observations with the caregiver may not be appropriate as the caregiver could be the source of abuse, and involving them first may jeopardize the client's safety.

2. A community health nurse is developing a program to address the opioid crisis in the community. Which intervention should the nurse prioritize?

• A. Providing education on the dangers of opioid use
• B. Distributing naloxone kits to first responders
• C. Offering support groups for individuals struggling with addiction
• D. Partnering with local pharmacies to monitor prescriptions

Correct answer: B

Rationale: The correct answer is B: Distributing naloxone kits to first responders. Naloxone is a medication that can rapidly reverse opioid overdose, potentially saving lives. In an opioid crisis scenario, providing naloxone kits to first responders equips them to act swiftly in emergencies. Choice A, providing education on the dangers of opioid use, is important but may not be as immediately life-saving as naloxone distribution. Choice C, offering support groups, is valuable for long-term recovery but may not address the acute crisis of overdoses. Choice D, partnering with local pharmacies to monitor prescriptions, focuses on prevention rather than immediate response to overdoses.

3. When developing a presentation on injury prevention for high school students in a health education class, which topic is most important for the nurse to include?

• A. Sports-related injuries
• B. Substance abuse
• C. Seat belt safety
• D. Pregnancy prevention

Correct answer: C

Rationale: The correct answer is C: Seat belt safety. This topic is crucial as it can significantly reduce the risk of injury or death in car accidents, which is a common cause of severe injuries among high school students. While sports-related injuries, substance abuse, and pregnancy prevention are important topics, seat belt safety directly addresses a preventable cause of injuries that can have immediate life-saving effects.

4. A client with hypertension is being seen in a community clinic. The nurse notes that the client has not been taking their prescribed medication regularly. What is the most appropriate initial intervention?

• A. Educate the client on the importance of medication adherence
• B. Explore the reasons for non-adherence with the client
• C. Refer the client to a hypertension specialist
• D. Adjust the client's medication regimen

Correct answer: B

Rationale: The most appropriate initial intervention when a client is not adhering to prescribed medication is to explore the reasons for non-adherence with the client. Understanding the client's perspective can help identify barriers to adherence, such as side effects, cost, forgetfulness, or misunderstanding of the treatment. By addressing these reasons, the nurse can work collaboratively with the client to develop strategies to improve medication compliance. Educating the client on the importance of adherence (Choice A) may be necessary but should come after exploring the reasons for non-adherence. Referring the client to a hypertension specialist (Choice C) or adjusting the medication regimen (Choice D) should be considered after addressing the underlying reasons for non-adherence.

5. The client with newly diagnosed type 1 diabetes mellitus is being taught about insulin administration by the nurse. Which statement indicates that the client needs further teaching?

• A. I will inject my insulin into my abdomen for the fastest absorption.
• B. I will rotate injection sites to prevent lipodystrophy.
• C. I will store my insulin in the refrigerator at all times.
• D. I will rotate injection sites to prevent lipodystrophy.

Correct answer: C

Rationale: The correct answer is C. Insulin should not be stored in the refrigerator at all times; it should be kept at room temperature when in use to avoid irritation at the injection site. Storing insulin in the refrigerator can cause it to thicken and may lead to discomfort upon injection. Choices A and D are correct statements as injecting insulin into the abdomen for faster absorption and rotating injection sites to prevent lipodystrophy are appropriate insulin administration techniques. Therefore, the client does not need further teaching on these aspects.

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