Nursing Elites

1. The nurse is caring for a 27-year-old female client with a venous stasis ulcer. Which nursing intervention would be most effective in promoting healing?

• A. Apply dressing using sterile technique
• B. Improve the client's nutrition status
• C. Initiate limb compression therapy
• D. Begin proteolytic debridement

Correct answer: B

Rationale: Venous stasis occurs when venous blood collects and stagnates in the lower leg due to incompetent venous valves. This leads to inadequate oxygen and nutrient supply to the cells in the lower extremities, resulting in cell death or necrosis. Venous stasis ulcers, characterized by shallow brown wounds with irregular margins, typically develop on the lower leg or ankle. The primary goal in managing clients with venous stasis ulcers is to promote healing. Proper nutrition plays a crucial role in wound healing. Nutritional deficiencies are common causes of venous ulcers, and a diet rich in protein, iron, zinc, and vitamins C and A is recommended to enhance wound healing. Applying dressings with sterile technique, initiating limb compression therapy, and beginning proteolytic debridement are important interventions in wound care but may not directly address the underlying issue of poor nutrition that is essential for healing venous stasis ulcers.

2. The nurse is caring for a 13-year-old following spinal fusion for scoliosis. Which of the following interventions is appropriate in the immediate post-operative period?

• A. Raise the head of the bed at least 30 degrees
• B. Encourage ambulation within 24 hours
• C. Maintain in a flat position, logrolling as needed
• D. Encourage leg contraction and relaxation after 48 hours

Correct answer: C

Rationale: In the immediate post-operative period following spinal fusion for scoliosis in a 13-year-old, it is important to maintain the patient in a flat position and perform logrolling as needed. This helps prevent injury to the surgical site and ensures proper spinal alignment. Raising the head of the bed at least 30 degrees is contraindicated as it can put strain on the surgical site. Encouraging ambulation within 24 hours may be appropriate in the recovery process but not in the immediate post-operative period. Encouraging leg contraction and relaxation after 48 hours may also be part of the rehabilitation process but is not a priority in the immediate post-operative period.

3. In educating clients on ways to manage pain, which topic can be appropriately delegated to an LPN/LVN who will continue under supervision?

• A. Acupuncture
• B. Guided Imagery
• C. Alternating Rest/Activity
• D. Over-the-counter medications

Correct answer: C

Rationale: The correct answer is 'Alternating Rest/Activity.' This topic falls within the nursing scope of practice and is typically covered in the training and education of all nurses, including LPN/LVNs. Educating clients on alternating rest and activity is safe, straightforward, and a standard non-pharmacological pain management strategy. Acupuncture (Choice A) and Guided Imagery (Choice B) involve specific skills and techniques that are typically outside the scope of practice for LPN/LVNs. Over-the-counter medications (Choice D) may require additional assessment, monitoring, and considerations that are beyond the usual delegation for LPN/LVNs.

4. When administering a-interferon and ribavirin (Rebetol) to a patient with chronic hepatitis C, the nurse should monitor for which complication?

• A. Leukopenia.
• B. Hypokalemia.
• C. Polycythemia.
• D. Hypoglycemia.

Correct answer: B

Rationale: When administering a-interferon and ribavirin (Rebetol) for chronic hepatitis C, the nurse should monitor for hypokalemia. This combination therapy is known to cause leukopenia, not polycythemia or hypoglycemia. Hypokalemia is a common electrolyte imbalance that can occur with these medications, making it the correct answer to monitor for in this case.

5. A patient in the emergency room has a fractured left elbow and presents with an unequal radial pulse, swelling, and numbness in the left hand after waiting for 5 hours. What is the nurse's priority intervention?

• A. Place the patient in a supine position
• B. Ask the patient to rate his pain on a scale of 1 to 10.
• C. Wrap the fractured area with a snug dressing
• D. Start an IV in the other arm.

Correct answer: D

Rationale: The correct answer is to start an IV in the other arm. In this scenario, the patient is showing signs of Acute Compartment Syndrome, a serious condition that occurs due to increased pressure within a muscle compartment, leading to decreased blood flow and potential tissue damage. Starting an IV is crucial as the patient may require emergency surgery, such as a fasciotomy, to relieve the pressure and prevent further complications. Placing the patient in a supine position, asking about pain levels, or wrapping the fractured area, though important, are not the priority interventions in this critical situation where immediate medical intervention is necessary to prevent irreversible damage or loss of limb.

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