Nursing Elites

1. The nurse is caring for 4 clients. What client should the nurse see first?

• A. A client with multiple children visiting
• B. A client with lupus asking for dinner
• C. A client on Methotrexate with a fever
• D. A client with chronic rheumatic pain

Correct answer: C

Rationale: The correct answer is the client on Methotrexate with a fever. Fever in a client on Methotrexate, an immunosuppressant, could indicate a serious infection or adverse drug reaction requiring immediate attention to prevent complications. The other choices do not present immediate life-threatening concerns. A client with lupus asking for dinner can wait, a client with chronic rheumatic pain may need pain management but is not the priority over a fever in a client on Methotrexate, and a client with children visiting does not pose an urgent medical issue.

2. A provider has ordered a wound culture for a client with a non-healing wound. What is the nurse's first action?

• A. Label the specimen tube
• B. Put on non-sterile gloves
• C. Gently remove the soiled dressings
• D. Irrigate the wound

Correct answer: B

Rationale:

3. A client is immobile and requires mechanical ventilation with a tracheostomy. She has a pressure injury on her coccyx measuring 5 cm by 3 cm. the nurse observes bone and tendon at the base of the wound. How would the nurse document this wound?

• A. Stage III pressure injury
• B. A stage II pressure injury
• C. A non-staging pressure injury
• D. Stage IV pressure injury

Correct answer: D

Rationale:

4. Which of the following statements made by a client diagnosed with human immunodefiency virus (HIV) would require further teaching?

• A. "I will have to be careful and avoid crowds."?
• B. "I will take prescribed medications."?
• C. "I will have to take medications for the rest of my life."?
• D. "I will only need to take HIV medications for 6 months, and I will be cured

Correct answer: D

Rationale:

5. What steps are NOT included in preparing a sterile field?

• A. Do not turn away from the sterile field
• B. Obtain PAPR mask
• C. Prepare the client before setting up the sterile field
• D. Cover the sterile field once it is set up

Correct answer: B

Rationale:

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