Nursing Elites

1. When caring for a client with a tracheostomy, which action should the nurse take first when performing tracheostomy care?

• A. Remove the inner cannula.
• B. Clean the stoma with normal saline.
• C. Change the tracheostomy ties.
• D. Suction the tracheostomy.

Correct answer: D

Rationale: Suctioning the tracheostomy is the priority action because it ensures a patent airway before proceeding with any other tracheostomy care interventions. This step helps clear secretions and maintain airway patency, which is crucial for the client's respiratory status. Removing the inner cannula, cleaning the stoma, or changing the tracheostomy ties can follow once the airway is clear. Therefore, options A, B, and C are secondary actions compared to suctioning the tracheostomy.

2. The client is receiving warfarin (Coumadin) therapy. Which statement by the client indicates a need for further teaching?

• A. I will avoid eating foods high in vitamin K.
• B. I will use a soft toothbrush and an electric razor.
• C. I will keep all appointments for blood tests.
• D. I will avoid participating in contact sports.

Correct answer: D

Rationale: The correct answer is D because participating in contact sports can increase the risk of injury and bleeding in a client receiving warfarin therapy. Warfarin is a blood thinner, and activities with a higher risk of injury should be avoided to prevent bleeding complications. Choices A, B, and C are all correct statements for a client on warfarin therapy. Avoiding foods high in vitamin K helps maintain consistent anticoagulation levels, using a soft toothbrush and an electric razor reduces the risk of bleeding gums and cuts, and keeping appointments for blood tests ensures proper monitoring of the client's international normalized ratio (INR) levels.

3. The parish nurse notes that an elderly male client has had a 5 lbs weight loss since his check-up one month ago. The client has good hygiene, still drives a car, and lives alone. To which agency should the nurse refer this client?

• A. the adult day care center
• B. the social security administration office
• C. the women, infants, and children office
• D. the senior citizen center

Correct answer: D

Rationale: The correct answer is 'D: the senior citizen center.' In this scenario, the elderly male client is experiencing unexplained weight loss, which could be indicative of underlying health issues or social isolation. Referring him to the senior citizen center is appropriate as it can provide social support, resources, and programs tailored to address the client's weight loss and overall well-being. Choice A, the adult day care center, is not the most suitable option as the client is still independent and living alone. Choice B, the social security administration office, and Choice C, the women, infants, and children office, are not relevant in this context and do not address the client's specific needs related to weight loss and social support.

4. A male client who has been taking propranolol (Inderal) for 18 months tells the nurse the healthcare provider discontinued the medication because his blood pressure has been normal for the past three months. Which instruction should the nurse provide?

• A. Abruptly stop the medication.
• B. Continue the medication at the same dose.
• C. Ask the healthcare provider about tapering the drug dose over the next week.
• D. Increase the dose of the medication.

Correct answer: C

Rationale: Gradually tapering the dose over one to two weeks should be recommended to prevent rebound tachycardia, hypertension, and ventricular dysrhythmias.

5. The instructor is teaching a prenatal class about the importance of folic acid. Which outcome indicates that the teaching was effective?

• A. participants can list foods high in folic acid
• B. participants plan to take folic acid supplements daily
• C. participants understand the risks of folic acid deficiency
• D. participants demonstrate how to read nutrition labels for folic acid content

Correct answer: B

Rationale: The correct answer is B because planning to take folic acid supplements daily is a proactive step towards preventing folic acid deficiency and reducing the risk of neural tube defects in pregnancy. While choice A is important for dietary knowledge, the direct action of taking supplements is more effective. Choice C, understanding the risks, is good but does not ensure action. Choice D, reading nutrition labels, is helpful but doesn't guarantee intake of folic acid.

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