Nursing Elites

1. How should a healthcare professional assess and manage a patient with a tracheostomy?

• A. Monitor for signs of infection and ensure airway patency
• B. Suction airway secretions and provide humidified air
• C. Inspect stoma site and clean with saline
• D. Provide education on tracheostomy care

Correct answer: A

Rationale: Correct answer: Monitoring for signs of infection and ensuring airway patency is crucial in managing a patient with a tracheostomy. This involves observing for redness, swelling, or discharge at the stoma site, as well as assessing for any signs of respiratory distress. Choice B, suctioning airway secretions and providing humidified air, is important for maintaining airway hygiene but may not be the initial assessment priority. Choice C, inspecting the stoma site and cleaning with saline, is part of routine tracheostomy care but does not address immediate assessment and management needs. Choice D, providing education on tracheostomy care, is valuable but not the primary action required in the assessment and management of a patient with a tracheostomy.

2. A client with multiple fractures following a motor-vehicle crash is struggling with opening a milk carton. Which of the following client statements should the nurse recommend a referral to an occupational therapist?

• A. I can't brush my teeth properly
• B. I am so frustrated I can't open my milk carton
• C. I can't hold a pencil
• D. I can't write anymore

Correct answer: B

Rationale: The correct answer is B. Struggling to open a milk carton indicates difficulty with fine motor skills and activities of daily living. This statement suggests a need for assistance from an occupational therapist to improve hand strength, coordination, and independence in performing essential tasks. Choices A, C, and D do not directly relate to the need for occupational therapy services in this context. In contrast, the inability to open a milk carton highlights specific challenges that occupational therapy can address effectively.

3. A nurse is reinforcing discharge instructions with the parent of an infant who has rotavirus. Which of the following statements by the parent indicates an understanding of the teaching?

• A. I will avoid feeding my baby for 12 hours
• B. I will apply diaper cream during each diaper change
• C. I will give my baby water between feedings
• D. I will apply warm compresses for my baby's comfort

Correct answer: B

Rationale: The correct answer is B. Applying diaper cream during each diaper change is important to prevent skin breakdown in infants with rotavirus. Rotavirus can cause diarrhea, which can lead to skin irritation. Avoiding feeding the baby for 12 hours (choice A) can lead to dehydration and is not appropriate. Giving water between feedings (choice C) can further contribute to dehydration. Applying warm compresses (choice D) may provide comfort but does not address the specific issue of preventing skin breakdown associated with rotavirus.

4. A client who is newly diagnosed with iron deficiency anemia needs to include foods rich in iron in their diet. Which of the following foods should the nurse recommend as having the highest amount of iron?

• A. Boiled spinach
• B. Raw carrots
• C. Boiled chicken
• D. Yogurt

Correct answer: A

Rationale: Boiled spinach is an excellent source of iron, making it a top choice for individuals with iron deficiency anemia. Spinach contains non-heme iron, which may not be absorbed as efficiently as heme iron from animal sources but is still beneficial. Raw carrots, boiled chicken, and yogurt are not as rich in iron compared to spinach. Carrots are more known for their beta-carotene content, chicken is a good source of protein but not high in iron, and yogurt does not contain significant amounts of iron.

5. Which of the following findings indicates a need for immediate attention in a client diagnosed with delirium?

• A. Confusion and disorientation that resolve with rest
• B. A blood pressure reading of 110/70
• C. Irritability and agitation that worsen throughout the day
• D. Mild confusion during the evening hours

Correct answer: C

Rationale: The correct answer is C: Irritability and agitation that worsen throughout the day. These symptoms are concerning in a client diagnosed with delirium as they may indicate an exacerbation of the condition or an underlying cause that requires immediate attention. Option A describes symptoms that resolve with rest, which may not be as urgent. Option B provides a normal blood pressure reading, which is not typically associated with immediate attention in delirium cases. Option D describes mild confusion during specific hours, which may not be as critical as worsening symptoms throughout the day.

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