Nursing Elites

1. The doctor orders 2% nitroglycerin ointment in a 1-inch dose every 12 hours. Proper application of nitroglycerin ointment includes:

• A. Rotating application sites
• B. Limiting applications to the chest
• C. Rubbing it into the skin
• D. Covering it with a thin paper dressing

Correct answer: A

Rationale: Proper application of nitroglycerin ointment involves rotating application sites to prevent skin irritation. It should be applied to the back and upper arms, not restricted to the chest, making option B incorrect. Rubbing it into the skin, as indicated in option C, is not recommended for nitroglycerin ointment as it can lead to faster absorption and potential side effects. The correct way is to cover it with a thin paper dressing, not gauze as mentioned in option D, to ensure proper absorption and prevent the medication from evaporating too quickly.

2. What is the first exercise that should be performed by a client who had a mastectomy?

• A. Walking the hand up the wall
• B. Sweeping the floor
• C. Combing her hair
• D. Squeezing a ball

Correct answer: D

Rationale: The correct answer is D: Squeezing a ball. The first exercise that should be done by a client with a mastectomy is squeezing a ball. This helps in regaining strength and mobility in the affected area. Choices A, B, and C are incorrect as they are not typically the initial exercises recommended post-mastectomy. Walking the hand up the wall, sweeping the floor, and combing hair are activities that may be introduced later in the rehabilitation process.

3. A client with cancer is admitted to the oncology unit. Stat lab values reveal Hgb 12.6, WBC 6500, K+ 1.9, uric acid 7.0, Na+ 136, and platelets 178,000. The nurse evaluates that the client is experiencing which of the following?

• A. Hypernatremia
• B. Hypokalemia
• C. Myelosuppression
• D. Leukocytosis

Correct answer: B

Rationale: The correct answer is 'Hypokalemia.' The potassium level of 1.9 indicates low potassium levels, a condition known as hypokalemia. The other lab values are within normal ranges: Hgb 12.6, WBC 6500, uric acid 7.0, Na+ 136, and platelets 178,000. Hypernatremia (choice A) refers to high sodium levels, which are not present in this case. Myelosuppression (choice C) is a decrease in bone marrow activity, which is not indicated by the lab values provided. Leukocytosis (choice D) is an increase in white blood cells, which is also not present based on the given values.

4. A client with acute leukemia develops a low white blood cell count. In addition to the institution of isolation, the nurse should:

• A. Request that foods be provided in sealed single-serving packages
• B. Ask the client to wear a mask when visitors are present
• C. Prep IV sites with mild soap and water and alcohol
• D. Provide foods in sealed single-serving packages

Correct answer: D

Rationale: For a client with acute leukemia and a low white blood cell count, preventing exposure to food contaminants is crucial due to immune suppression. Providing foods in sealed single-serving packages helps reduce the risk of contamination. Choice B is incorrect as it introduces the potential of infection from visitors. Choice A, suggesting disposable utensils, is not as effective as sealed containers in preventing food contamination. Choice C, using alcohol for prepping IV sites, is less suitable due to its drying effect and potential for skin breakdown, making sealed packages a better option for food safety.

5. The nurse is caring for a client scheduled for a surgical repair of a sacular abdominal aortic aneurysm. Which assessment is most crucial during the preoperative period?

• A. Assessment of the client's level of anxiety
• B. Evaluation of the client's exercise tolerance
• C. Identification of peripheral pulses
• D. Assessment of bowel sounds and activity

Correct answer: C

Rationale: The most crucial assessment during the preoperative period for a client scheduled for surgical repair of a sacular abdominal aortic aneurysm is the identification of peripheral pulses. This is essential because during surgery, the aorta will be clamped, potentially affecting blood circulation to the kidneys and lower extremities. Monitoring peripheral pulses helps assess circulation to the lower extremities, ensuring adequate perfusion. While assessing the client's anxiety level (choice A) is important, it is not as critical as monitoring peripheral pulses in this case. Evaluating exercise tolerance (choice B) is not typically recommended preoperatively for this specific condition. Assessing bowel sounds and activity (choice D) is also relevant but takes a lower priority compared to identifying peripheral pulses in this scenario.

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