Nursing Elites

1. The nurse is preparing to administer a subcutaneous injection of insulin to a client with diabetes. What is the best site for the nurse to select for this injection?

• A. Ventrogluteal site
• B. Dorsogluteal site
• C. Deltoid site
• D. Abdomen

Correct answer: D

Rationale: The correct answer is 'D: Abdomen.' The abdomen is the best site for insulin injections as it provides a larger area with consistent absorption rates due to the high vascularity of the area. The subcutaneous tissue in the abdomen allows for a more predictable and consistent absorption of insulin compared to other sites. Ventrogluteal and dorsogluteal sites are not commonly used for insulin injections due to the risk of hitting the sciatic nerve or causing tissue damage. The deltoid site is more commonly used for intramuscular injections rather than subcutaneous injections like insulin.

2. The nurse plans to assist a male client out of bed for the first time since his surgery yesterday. His wife objects and tells the nurse to get out of the room because her husband is too ill to get out of bed.

• A. Administer nasal oxygen at a rate of 5 L/min
• B. Help the client to lie back down in the bed
• C. Quickly pivot the client to the chair and elevate the legs
• D. Check the client’s blood pressure and pulse deficit

Correct answer: D

Rationale: Checking the client’s blood pressure and pulse deficit is essential before mobilizing a client out of bed, especially after surgery. This assessment helps ensure the client's stability and readiness for mobilization. Administering oxygen or pivoting the client without prior assessment could pose risks if the client is not medically stable. Helping the client lie back down without proper evaluation may delay necessary interventions if the client is indeed ready for mobilization.

3. The healthcare professional is caring for a client who is post-operative following a hip replacement. Which assessment finding would require immediate intervention?

• A. Pain at the surgical site
• B. Swelling in the affected leg
• C. Elevated temperature
• D. Shortness of breath

Correct answer: D

Rationale: Shortness of breath is a critical assessment finding that could indicate a pulmonary embolism or other serious complication related to surgery, such as a respiratory issue or cardiac problem. Immediate intervention is necessary to prevent further complications or harm to the client. Pain at the surgical site is common post-operatively and can be managed with appropriate pain relief measures. Swelling in the affected leg is expected after a hip replacement and can often be managed conservatively or monitored closely. An elevated temperature could be a sign of infection, which is important to address but may not require immediate intervention unless other symptoms of sepsis are present.

4. A nurse is assigned to a manipulative client for 5 days and becomes aware of feelings of reluctance to interact with the client. What should the nurse do next?

• A. Discuss the feelings of reluctance with an objective peer or supervisor
• B. Limit contacts with the client to avoid reinforcement of the manipulative behavior
• C. Confront the client about the negative effects of behaviors on other clients and staff
• D. Develop a behavior modification plan that will promote more functional behavior

Correct answer: A

Rationale: It is important for the nurse to address their feelings of reluctance when dealing with a manipulative client by discussing them with an objective peer or supervisor. This action can provide valuable insight and support for managing the nurse-client relationship. Choice B should be avoided as limiting contacts with the client may not address the underlying issues and could potentially harm the therapeutic relationship. Choice C is confrontational and may escalate the situation rather than resolve it. Choice D, while important, should come after addressing the nurse's feelings and seeking support.

5. When changing a client's colostomy pouch and noticing peristomal skin irritation, which of the following actions should the nurse take?

• A. Change the pouch as needed based on individual requirements.
• B. Apply the pouch only when the skin barrier is completely dry.
• C. Pat the peristomal skin dry after cleaning.
• D. Ensure the pouch is 0.32 cm (1/8 in) larger than the stoma.

Correct answer: D

Rationale: When a nurse observes peristomal skin irritation while changing a client's colostomy pouch, it is crucial to ensure that the pouch is slightly larger (0.32 cm or 1/8 inch) than the stoma. This extra space helps prevent the pouch from rubbing against the stoma and causing further irritation. Option A is correct because colostomy pouches should be changed based on individual needs, not necessarily every 24 hours. Option B is incorrect because applying the pouch only when the skin barrier is completely dry ensures better adhesion. Option C is incorrect as patting the peristomal skin dry after cleaning is more gentle and less likely to cause irritation compared to rubbing.

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