Nursing Elites

1. 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.

2. Which of the following roommates would be best for the client newly admitted with gastric resection?

• A. A client with Crohn's disease
• B. A client with pneumonia
• C. A client with gastritis
• D. A client with phlebitis

Correct answer: D

Rationale: The most suitable roommate for the client newly admitted with gastric resection is the client with phlebitis. Phlebitis is an inflammation of the blood vessel and is not infectious, making it a safer option for the surgical client. Crohn's disease clients (choice A) have frequent stools that might spread infections to the surgical client, posing a risk. A client with pneumonia (choice B) is coughing, which can disturb the gastric client's recovery. Additionally, a client with gastritis (choice C) who is vomiting and experiencing diarrhea would also not be an ideal roommate for a client recovering from gastric resection.

3. The LPN is teaching a first-time mother about breastfeeding her newborn. Which statement, if made by the mother, would reflect that the teaching had been successful?

• A. "My baby should be having at least 4-6 wet diapers a day until 1 month."?
• B. "It's nice that breastfed babies eat a bit less than formula-fed babies."?
• C. "My baby should be nursing 8-12 times a day during this period."?
• D. "I'm a little nervous about my milk coming in tomorrow. I've heard it's uncomfortable."?

Correct answer: C

Rationale: The correct answer is, '"My baby should be nursing 8-12 times a day during this period."?' This statement indicates successful teaching because newborns should nurse 8-12 times during the newborn period to ensure they receive adequate nutrition and establish a good milk supply. This frequency helps in meeting the baby's demands for growth and development. Choice A is incorrect because while it mentions the appropriate number of wet diapers a day once the mother's milk comes in, it does not reflect successful teaching about breastfeeding frequency. Choice B is incorrect because it discusses feeding amounts in comparison to formula-fed babies, which is not a direct indicator of successful breastfeeding teaching. Choice D is incorrect because it focuses on the mother's concerns about milk coming in, not on understanding the feeding frequency needed for the newborn.

4. A 32-year-old female frequently comes to her primary care provider with vague complaints of headache, abdominal pain, and trouble sleeping. In the past, the physician has dutifully prescribed medication, but little else. Which of the following comments by the nurse to the physician is appropriate?

• A. "Often women who are victims of domestic violence suffer vague symptoms such as abdominal pain."?
• B. "Often women become offended if asked about their safety in relationships."?
• C. "It is mandatory that all women be questioned about domestic violence."?
• D. "How would you feel to know that her partner is beating her and you didn't ask?"?

Correct answer: A

Rationale: The correct answer is, "Often women who are victims of domestic violence suffer vague symptoms such as abdominal pain."? There is a well-documented correlation between vague symptoms like abdominal pain and battered woman syndrome. It is crucial for healthcare providers to inquire about potential domestic violence when presented with such symptoms. Choice B is incorrect as studies show that women are not generally offended by appropriately phrased questions about their safety in relationships. While it is not mandatory to question all women about domestic violence, it is advisable to at least ask a screening question regarding safety. Choice D is inappropriate as it uses a shaming tactic, which is not constructive and may create a hostile work environment. It's important for healthcare professionals to approach sensitive topics like domestic violence with empathy and professionalism.

5. The nurse is assigning staff for the day. Which assignment should be given to the nursing assistant?

• A. Taking the vital signs of the 5-month-old with bronchiolitis
• B. Taking the vital signs of the 10-year-old with a 2-day postappendectomy
• C. Administering medication to the 2-year-old with periorbital cellulitis
• D. Adjusting the traction of the 1-year-old with a fractured tibia

Correct answer: B

Rationale: The most appropriate assignment for a nursing assistant is to take the vital signs of a stable patient. A 10-year-old with a 2-day postappendectomy is considered stable, and routine vital signs monitoring can be safely delegated to a nursing assistant. Clients with bronchiolitis, periorbital cellulitis, and a fractured tibia require more specialized care and assessment by a licensed nurse. Bronchiolitis involves an airway alteration, periorbital cellulitis indicates an infection, and a fractured tibia may raise concerns of abuse. Therefore, options A, C, and D are incorrect for delegation to a nursing assistant.

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