Nursing Elites

1. Patients have a right to ______________.

• A. only enough information so they can comply with care
• B. ALL of their health-related information
• C. small amounts of information so they do not get nervous
• D. moderate amounts of information unless they are old

Correct answer: ALL of their health-related information

Rationale: Patients have a legal right to access all of their health-related information. This includes details about their health condition, treatment options, test results, and any other relevant data. Providing patients with all their health-related information empowers them to make informed decisions about their care, promotes transparency in the healthcare process, and respects their autonomy. Choices A, C, and D are incorrect because they restrict the information patients should receive based on assumptions or limitations, which goes against the principle of patient autonomy and their right to access their complete health-related information.

2. A physician's order instructs a nurse to take a temperature at the axilla. Where would the nurse place the thermometer?

• A. In the rectum
• B. In the mouth
• C. On the temples
• D. In the armpit

Correct answer: In the armpit

Rationale: When a physician's order specifies taking a temperature at the axilla, the nurse should place the thermometer in the armpit. The axilla is the anatomical area of the armpit located under the arms, proximal to the trunk. Placing the thermometer in the rectum (Choice A) is used for rectal temperature measurements, in the mouth (Choice B) for oral temperature measurements, and on the temples (Choice C) is not a common site for temperature assessment. Therefore, the correct placement based on the given instruction is in the armpit.

3. Which of the following is the correct sequence for removing personal protective equipment?

• A. Remove gown, gloves, shoe covers, mask
• B. Remove mask, gloves, gown, shoe covers
• C. Remove gloves, gown, mask, shoe covers
• D. Remove shoe covers, mask, gloves, gown

Correct answer: Remove gloves, gown, mask, shoe covers

Rationale: The correct sequence for removing personal protective equipment is crucial to prevent contamination. When exiting a surgical or aseptic situation, the proper sequence is to first remove gloves, followed by the gown, mask, and finally shoe covers. This order ensures that potentially contaminated items are removed first, minimizing the risk of exposure. Choice A, 'Remove gown, gloves, shoe covers, mask,' is incorrect as gloves should be removed before the gown. Choice B, 'Remove mask, gloves, gown, shoe covers,' is incorrect as gloves should be removed first. Choice D, 'Remove shoe covers, mask, gloves, gown,' is incorrect as gloves should be the first item removed to prevent contamination.

4. During an examination, a nurse notices a draining ulceration on a patient’s lower leg. What is the most appropriate action in this situation?

• A. Wash hands and then contact the physician.
• B. Continue to examine the ulceration and then wash hands.
• C. Wash hands, put on gloves, and continue with the examination of the ulceration.
• D. Wash hands, proceed with the rest of the physical examination, and perform the examination of the leg ulceration last.

Correct answer: C: Wash hands, put on gloves, and continue with the examination of the ulceration.

Rationale: In this scenario, the most appropriate action is to wash hands, put on gloves, and then continue examining the ulceration. Wearing gloves is crucial when there is a possibility of contact with body fluids, as in the case of a draining ulceration. Contacting the physician is not necessary at this point; the immediate focus should be on proper infection control by washing hands and wearing gloves. Changing the order of the examination is not recommended as it is important to follow a systematic approach to avoid missing any crucial assessments.

5. Which technique of assessment will the healthcare provider use to determine the presence of crepitus, swelling, and pulsations?

• A. Palpation
• B. Inspection
• C. Percussion
• D. Auscultation

Correct answer: Palpation

Rationale: Palpation involves using the sense of touch to assess various characteristics such as texture, temperature, moisture, organ location and size, as well as detecting swelling, pulsations, vibrations, rigidity, crepitus, lumps, masses, and tenderness or pain. In this scenario, the healthcare provider would utilize palpation to physically feel for crepitus, swelling, and pulsations. Inspection primarily relies on visual assessment, percussion involves assessing through palpable vibrations and audible sounds, and auscultation uses the sense of hearing. Therefore, the correct answer is palpation for assessing the presence of crepitus, swelling, and pulsations.

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