Nursing Elites

1. Following change-of-shift report on an orthopedic unit, which client should the nurse see first?

• A. 16-year-old who had an open reduction of a fractured wrist 10 hours ago
• B. 20-year-old in skeletal traction for 2 weeks since a motorcycle accident
• C. 72-year-old recovering from surgery after a hip replacement 2 hours ago
• D. 75-year-old who is in skin traction prior to planned hip pinning surgery

Correct answer: C

Rationale: The 72-year-old recovering from surgery after a hip replacement 2 hours ago should be seen first due to the potential for immediate post-operative complications. This patient is in the immediate postoperative period and requires close monitoring for any signs of complications such as bleeding, infection, or impaired circulation. The other patients are relatively stable compared to the patient who just had surgery and therefore can wait for assessment and care without immediate risk. The 16-year-old had surgery ten hours ago, which is longer than the 72-year-old and is at a lower risk for immediate complications. The 20-year-old in skeletal traction for two weeks is stable in his current condition. The 75-year-old in skin traction before planned surgery does not require immediate attention as the surgery has not yet taken place.

2. At the time of the first dressing change, the client refuses to look at her mastectomy incision. The LPN tells the client that the incision is healing well, but the client refuses to talk about it. What would be an appropriate response to this client's silence?

• A. It is normal to feel angry and depressed, but the sooner you deal with this surgery, the better you will feel.
• B. Looking at your incision can be frightening, but facing this fear is a necessary part of your recovery.
• C. It is OK if you don't want to talk about your surgery. I will be available when you are ready.
• D. I will ask a woman who has had a mastectomy to come by and share her experiences with you.

Correct answer: C

Rationale: In this situation, it's essential to acknowledge and respect the client's feelings and choices. Choice C is the most appropriate response as it validates the client's decision not to discuss the surgery while offering support and understanding. Giving the client space and letting them know you will be available when they are ready shows empathy and fosters trust. Choices A and B do not respect the client's autonomy and may come across as dismissive or pressuring. Choice D assumes the client needs advice from someone who has had a similar experience without considering the client's current emotional state and preferences.

3. A healthcare professional is teaching about home safety with a client. Which of the following instructions should the healthcare professional include?

• A. Unplug electronics by holding the plug
• B. Use electrical tape to secure extension cords next to baseboards on the floor
• C. To use a fire extinguisher, aim at the base of the flames
• D. Install slip-resistant rugs on tile floors

Correct answer: B

Rationale: The correct answer is to use electrical tape to secure extension cords next to baseboards on the floor. This practice helps prevent tripping and electrical hazards by keeping cords out of the way. Option A is incorrect as unplugging electronics should be done by holding the plug, not the cord itself. Option C is incorrect because when using a fire extinguisher, it should be aimed at the base of the flames, not at the top. Option D is not directly related to home safety teaching and may not be necessary for all clients, as it suggests an unnecessary change that may not improve safety.

4. Seconal 0.1 gram PRN at bedtime is prescribed to a client for rest. The scored tablets are labeled 1.5 grains per tablet. How many tablets should the LPN/LVN plan to administer?

• A. 0.5 tablet
• B. 1 tablet
• C. 1.5 tablets
• D. 2 tablets

Correct answer: B

Rationale: To calculate the number of tablets needed, convert the prescribed dose of Seconal from grams to grains. Since 1 gram is equal to approximately 15.43 grains, 0.1 gram is roughly 1.543 grains. Given that each tablet contains 1.5 grains, administering 1 tablet (which is slightly more than the 1.543 grains needed) provides the correct dose of Seconal. Therefore, the LPN/LVN should plan to administer 1 tablet. Choice A (0.5 tablet) is incorrect as it would provide less than the required dose. Choice C (1.5 tablets) and Choice D (2 tablets) are incorrect as they would exceed the necessary dosage.

5. A client is receiving discharge teaching about a new prescription for digoxin (Lanoxin). Which statement by the client indicates a need for further teaching?

• A. I should avoid foods high in potassium while taking this medication.
• B. I will check my pulse before taking the medication.
• C. I should avoid taking antacids simultaneously with this medication.
• D. I will take the medication at the same time every day.

Correct answer: A

Rationale: The correct answer is A because clients taking digoxin should avoid foods high in potassium. High potassium levels can potentiate the effects of digoxin, leading to toxicity. Choices B, C, and D are correct statements regarding digoxin administration. Checking the pulse before taking the medication helps monitor for signs of digoxin toxicity. Avoiding taking antacids simultaneously prevents interactions that may reduce digoxin absorption. Taking the medication at the same time every day helps maintain a consistent blood level, ensuring optimal therapeutic effects.

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