Nursing Elites

1. The client with atrial fibrillation is being taught about the use of Coumadin (warfarin) at home. Which of these should be emphasized to the client to avoid?

• A. Large indoor gatherings
• B. Exposure to sunlight
• C. Active physical exercise
• D. Foods rich in vitamin K

Correct answer: D

Rationale: The correct answer is D: Foods rich in vitamin K. Foods rich in vitamin K can interfere with the effectiveness of Coumadin (warfarin) by promoting blood clotting. It is crucial for clients on this medication to maintain a consistent intake of vitamin K and avoid sudden dietary changes. Choices A, B, and C are incorrect as they are not directly related to the interaction of Coumadin (warfarin) with vitamin K. Large indoor gatherings, exposure to sunlight, and active physical exercise do not have a significant impact on the effectiveness of Coumadin (warfarin) in comparison to the interaction with foods rich in vitamin K.

2. Which of the following patients should the home care nurse assess first?

• A. A 65-year-old male with known COPD and difficulty breathing after climbing a flight of stairs.
• B. A 78-year-old with CHF who has gained 4 lbs according to her tele-monitoring.
• C. A 50-year-old with bilateral leg swelling and difficulty walking.
• D. A 60-year-old with lower back pain.

Correct answer: A

Rationale: The correct answer is A. A patient with known COPD and difficulty breathing after physical exertion like climbing stairs requires immediate assessment by the nurse. This could indicate a potential exacerbation of COPD, which needs prompt intervention to prevent respiratory distress. Choices B, C, and D describe important patient situations that also require attention, but the urgency is higher with a COPD patient experiencing difficulty breathing.

3. A client asks the nurse about including her 2 and 12-year-old sons in the care of their newborn sister. Which of the following is an appropriate initial statement by the nurse?

• A. Focus on your sons' needs during the first days at home.
• B. Tell each child what he can do to help with the baby.
• C. Suggest that your husband spend more time with the boys.
• D. Ask the children what they would like to do for the newborn.

Correct answer: A

Rationale: The correct answer is A. Focusing on the older children's needs during the initial days at home is crucial as it helps them feel secure and valued during the transition. This approach allows the children to adjust to the new family dynamics and feel included in the care of their newborn sister. Choice B is incorrect as it focuses on tasks rather than addressing the children's emotional needs. Choice C is not the initial step and does not involve directly addressing the children's needs. Choice D puts the decision-making burden on the children rather than providing guidance and support.

4. When providing nursing care to a client receiving oxygen therapy via a nasal cannula, which of the following interventions would be appropriate?

• A. Ensure that adequate mist is supplied
• B. Inspect the nares and ears for skin breakdown
• C. Lubricate the tips of the cannula before insertion
• D. Maintain sterile technique when handling the cannula

Correct answer: B

Rationale: The correct answer is to inspect the nares and ears for skin breakdown. This is important because the nasal cannula can cause skin breakdown due to prolonged use and friction. Ensuring that the skin is intact helps prevent complications. Choice A is incorrect as oxygen therapy via a nasal cannula does not involve mist. Choice C is incorrect as lubricating the tips of the cannula is not a standard practice and may lead to complications. Choice D is incorrect because while cleanliness is important, maintaining sterile technique is not necessary for handling a nasal cannula in this context.

5. A community health nurse is developing a program to decrease the incidence of Type 2 diabetes in the community. Which of the following interventions should be included?

• A. distributing brochures on managing diabetes
• B. conducting exercise classes at the community center
• C. providing free glucose monitors
• D. offering dietary counseling sessions

Correct answer: B

Rationale: The correct answer is B: conducting exercise classes at the community center. Regular physical activity plays a crucial role in preventing Type 2 diabetes by helping to maintain a healthy weight, improve insulin sensitivity, and regulate blood sugar levels. Distributing brochures (choice A) may raise awareness but might not lead to significant behavior change. Providing free glucose monitors (choice C) focuses on monitoring rather than prevention. Offering dietary counseling sessions (choice D) is important but focusing solely on diet may not address the comprehensive approach needed to prevent Type 2 diabetes.

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