Nursing Elites

1. The licensed practical nurse is observing a graduate nurse as she assesses the central venous pressure. Which observation would indicate that the graduate needs further teaching?

• A. The graduate places the client in a supine position to read the manometer.
• B. The graduate turns the stop-cock to the off position from the IV fluid to the client.
• C. The graduate instructs the client to perform the Valsalva maneuver during the CVP reading.
• D. The graduate notes the level at the top of the meniscus.

Correct answer: C

Rationale: The correct answer is C because the client should breathe normally during a central venous pressure monitor reading. Placing the client in a supine position (Choice A) is correct if the client can tolerate it. Turning the stop-cock off (Choice B) and noting the level at the top of the meniscus (Choice D) are also correct actions during CVP monitoring. Instructing the client to perform the Valsalva maneuver is incorrect as it can artificially alter the CVP reading, indicating a need for further teaching.

2. Which of the following post-operative diets is most appropriate for the client who has had a hemorrhoidectomy?

• A. High-fiber
• B. Low-residue
• C. Bland
• D. Clear-liquid

Correct answer: D

Rationale: The correct answer is 'Clear-liquid.' After a hemorrhoidectomy, the client is usually started on a clear-liquid diet to allow the intestines to rest and promote healing. This diet helps prevent straining during bowel movements, which is crucial for recovery. Stool softeners are often included in the plan to avoid constipation. Once the client tolerates the clear liquids well, they can progress to a regular diet. High-fiber diet (choice A) is beneficial in the later stages of recovery to prevent constipation but is not typically the initial post-operative diet. Low-residue diet (choice B) and bland diet (choice C) are not appropriate for this type of surgery as they may not provide the necessary post-operative care and support needed for healing.

3. A client is taking hydrocodone (Vicodin) for chronic back pain. The client has required an increase in the dose and asks whether this means he is addicted to Vicodin. The nurse should base her reply on the knowledge that:

• A. the client's body has developed tolerance, requiring more drug to produce the same effect.
• B. the client is preoccupied with getting the drug and is experiencing loss of control, indicating drug dependence.
• C. addiction is the term used to describe physical dependence with withdrawal symptoms and tolerance.
• D. the client has a dual diagnosis of substance abuse and chronic back pain

Correct answer: A

Rationale: Drug tolerance is characterized by the ability to ingest a larger dose without adverse effects and decreased sensitivity to the substance. In this scenario, the client needing an increased dose of hydrocodone to achieve the same pain relief indicates tolerance developing, not addiction. Choice B is incorrect as it describes drug dependence, where the individual is preoccupied with the drug and has a loss of control. Choice C is incorrect because addiction involves psychological behaviors related to substance use, not just physical dependence with withdrawal symptoms and tolerance. Choice D is incorrect as it refers to a dual diagnosis, which is the coexistence of substance abuse and psychiatric disorders, not the development of tolerance to a drug.

4. A home health nurse is making preparations for morning visits. Which one of the following clients should the nurse visit first?

• A. A client with brain attack (stroke) receiving tube feedings
• B. A client with congestive heart failure complaining of nighttime dyspnea
• C. A client who had a thoracotomy 6 months ago
• D. A client with Parkinson’s disease

Correct answer: B

Rationale: The correct answer is B. The client with congestive heart failure complaining of nighttime dyspnea should be seen first as airway management is a priority in nursing care. This client's symptoms indicate potential respiratory distress, requiring immediate attention. Choices A, C, and D involve clients who are more stable and do not present with urgent or acute conditions that require immediate intervention. Choice A with a client receiving tube feedings for a stroke may require attention, but the urgency of addressing potential respiratory distress in choice B takes precedence. Choice C, a client who had a thoracotomy 6 months ago, unless presenting with acute distress, does not necessitate immediate attention. Choice D, a client with Parkinson's disease, is usually a chronic condition that does not typically require immediate intervention for the described scenario.

5. A 6-month-old client is admitted with possible intussusception. Which question during the nursing history is least helpful in obtaining information regarding this diagnosis?

• A. "Tell me about his pain."?
• B. "What does his vomit look like?"?
• C. "Describe his usual diet."?
• D. "Have you noticed changes in his abdominal size?"?

Correct answer: C

Rationale: The least helpful question in obtaining information regarding intussusception is "Describe his usual diet."? This question is least relevant to the specific symptoms and presentation of intussusception. Choices A, B, and D are more directly related to symptoms commonly associated with intussusception and can provide important diagnostic clues. Asking about pain, vomit appearance, and changes in abdominal size can help in assessing the severity and progression of the condition, making them more crucial questions to ask in this scenario. Pain is a cardinal symptom of intussusception, changes in vomit appearance may indicate gastrointestinal issues, and alterations in abdominal size can signify the presence of a mass or obstruction, all of which are pertinent in diagnosing and managing intussusception.

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