Nursing Elites

1. A test that can correctly identify those who do not have a given disease is:

• A. specific.
• B. sensitive.
• C. negative culture
• D. marginal finding.

Correct answer: A

Rationale: The correct answer is 'specific.' Specificity refers to the ability of a test to correctly identify individuals who do not have a particular disease. In this case, when the client's lab culture report is negative for the suspected infection, a specific test would correctly identify that the client does not have the disease. 'Sensitive' (Choice B) is incorrect as sensitivity refers to the ability of a test to correctly identify individuals who do have the disease. 'Negative culture' (Choice C) is incorrect as it does not describe the test's ability but rather the result itself. 'Marginal finding' (Choice D) is irrelevant to the concept being tested in this question.

2. The LPN is receiving the report on a comatose client at the start of the shift at 1500. What statement should be of most concern?

• A. The client was repositioned on his right side at 1100.
• B. The client was bathed, and the skin was assessed head-to-toe at 0900 with no abnormal findings.
• C. The client's PEG tube was changed 6 months ago.
• D. The client's indwelling urinary catheter was last changed 5 days ago.

Correct answer: D

Rationale: When caring for a comatose client, it is crucial to monitor and maintain the integrity of the indwelling urinary catheter to prevent urinary tract infections and other complications. Changing the urinary catheter less frequently than recommended increases the risk of infection. In this scenario, the most concerning issue is the prolonged duration since the last change of the indwelling urinary catheter, which poses an immediate risk to the client's health. While repositioning every 2 hours is essential to prevent skin breakdown, the most critical aspect in this case is the catheter care. Bathing and skin assessment are important for overall hygiene and skin integrity but are not as urgent as catheter care. The timing of the PEG tube change, while relevant for care planning, is not as immediate a concern as the indwelling urinary catheter status.

3. When a drug is listed as Category X and prescribed to women of child-bearing age/capacity, the nurse and the interdisciplinary team should counsel the client that:

• A. Pregnancy tests are not reliable while taking the drug.
• B. She must use a reliable form of birth control.
• C. She should not take the Category X drug on days she has intercourse.
• D. She must follow up with an endocrinologist.

Correct answer: B

Rationale: When a drug is categorized as Category X, it signifies that there are significant risks of fetal abnormalities if taken during pregnancy. For this reason, women of child-bearing age/capacity should use reliable forms of birth control to prevent pregnancy while on the medication. This ensures that the client avoids the potential harm to the fetus. Option A is incorrect because pregnancy tests are not unreliable due to the drug, but rather the risk is related to potential harm to the fetus. Option C is incorrect as avoiding the drug only on days of intercourse does not provide sufficient protection against pregnancy. Option D is incorrect as the need for an endocrinologist is not directly related to the use of Category X drugs.

4. A licensed practical nurse (LPN) in the long-term care unit who has another LPN and a nursing assistant on the nursing team is planning task assignments for the day. Which task should the nurse assign to the LPN?

• A. Monitoring a client receiving oxygen who requires frequent pulse oximetry monitoring and respiratory treatments
• B. Assisting a client who is wearing eye patches and requires assistance with hygiene measures
• C. Feeding a client on bedrest who needs assistance with feeding
• D. Turning a client who must be turned and repositioned every 2 hours

Correct answer: A

Rationale: When a nurse assigns tasks for a client's care to another staff member, the nurse is responsible for appropriately assigning tasks based on the educational level and competency of the staff member. In this scenario, the LPN should be assigned the task of monitoring a client receiving oxygen who requires frequent pulse oximetry monitoring and respiratory treatments. This is because the LPN is competent to perform these tasks and can accurately note changes in the client's condition. Tasks such as feeding a client, turning and repositioning a client, and assisting with hygiene measures, which are noninvasive interventions, can be assigned to a nursing assistant. These tasks do not require the same level of assessment and monitoring as the respiratory treatments and pulse oximetry monitoring.

5. The nurse receives an assignment of three clients. Which of the following should the nurse consider as the highest priority when determining which client to assess first?

• A. the client who most recently rang their call bell
• B. the client who has been waiting the longest for their call bell to be answered
• C. the client who is in the most pain
• D. the client who may have a risk for an airway obstruction

Correct answer: D

Rationale: The nurse should prioritize assessing a client with a potential airway obstruction first based on the ABCs (airway, breathing, circulation) principle. Maintaining a clear airway is crucial for oxygenation and ventilation, making it the highest priority. Choices A and B focus on call bells and waiting times, which are important but not life-threatening in comparison to airway concerns. While pain management is essential, it takes precedence after addressing immediate life-threatening issues like airway compromise.

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