Nursing Elites

1. The healthcare provider receives a report on four clients who are complaining of increased pain. Which client requires immediate attention by the healthcare provider?

• A. Burning pain due to a Morton’s neuroma
• B. Sharp pain related to a crushed femur
• C. Paresthesia of fingers due to carpal tunnel syndrome
• D. Stinging pain related to plantar fasciitis

Correct answer: B

Rationale: Sharp pain related to a crushed femur indicates a severe condition and potential serious complications that require immediate attention. Crushed femur can lead to severe bleeding, nerve damage, or compartment syndrome, which are critical and life-threatening. The other choices, although painful, are less likely to present immediate life-threatening issues. Morton’s neuroma, carpal tunnel syndrome, and plantar fasciitis are painful conditions but are not typically associated with urgent, life-threatening complications like a crushed femur.

2. An adult client with severe depression was admitted to the psychiatric unit yesterday evening. Although the client used to run a year ago, his spouse states that the client no longer runs but sits and watches television most of the day. Which is most important for the nurse to include in this client’s plan of care for today?

• A. Assist the client in identifying goals for the day
• B. Encourage the client to participate in a team sport for one hour
• C. Schedule the client for a group session that focuses on self-esteem
• D. Help the client develop a list of daily affirmations

Correct answer: A

Rationale: Assisting the client in identifying goals for the day is the most important aspect of the plan of care for a client with severe depression. Setting achievable daily goals helps engage the client in activities and promotes a sense of accomplishment, which can contribute to gradual improvement in their condition. Encouraging participation in team sports may be overwhelming for a client with severe depression as it requires a significant level of energy and motivation that the client may not possess at this time. Group sessions focusing on self-esteem and daily affirmations are beneficial interventions, but they may not have an immediate impact compared to setting achievable daily goals that can provide a sense of purpose and achievement for the client.

3. The nurse plans to collect a 24-hour urine specimen for a creatinine clearance test. Which instruction should the nurse provide to the adult male client?

• A. Urinate at the specified time, discard this urine, and collect all subsequent urine over the next 24 hours.
• B. Cleanse around the meatus, discard the first portion of voiding, and collect the rest in a sterile bottle.
• C. For the next 24 hours, notify the nurse when the bladder is full, and the nurse will collect catheterized specimens.
• D. Urinate immediately into a urinal, and the lab will collect the specimen every 6 hours for the next 24 hours.

Correct answer: A

Rationale: The correct instruction for the adult male client to follow when collecting a 24-hour urine specimen for a creatinine clearance test is to urinate at the specified time, discard this urine, and collect all subsequent urine over the next 24 hours. This method ensures proper collection for an accurate creatinine clearance measurement. Choice B is incorrect as it describes a different procedure for a clean-catch urine sample, not suitable for creatinine clearance. Choice C is incorrect as it suggests catheterization, which is not typically done for a creatinine clearance test, and it is not necessary for this procedure. Choice D is incorrect as it does not follow the standard procedure for a 24-hour urine collection for creatinine clearance; the urine should be collected continuously over 24 hours, not at specified intervals.

4. A female client has been taking a high dose of prednisone, a corticosteroid, for several months. After stopping the medication abruptly, the client reports feeling very tired. Which nursing intervention is most important for the nurse to implement?

• A. Measure vital signs
• B. Auscultate breath sounds
• C. Palpate the abdomen
• D. Observe the skin for bruising

Correct answer: A

Rationale: Discontinuing prednisone abruptly can lead to adrenal insufficiency, which may result in symptoms such as fatigue. Monitoring vital signs is crucial in this situation to assess for potential complications like hypotension, which can be a sign of adrenal insufficiency. Auscultating breath sounds (choice B) is important but not the priority when considering the risk of adrenal insufficiency. Palpating the abdomen (choice C) and observing the skin for bruising (choice D) are not directly related to the potential complications of abruptly stopping prednisone.

5. The healthcare provider explains through an interpreter the risks and benefits of a scheduled surgical procedure to a non-English speaking female client. The client gives verbal consent, and the healthcare provider leaves, instructing the nurse to witness the signature on the consent form. The client and interpreter then speak together in the foreign language for an additional 2 minutes until the interpreter concludes, 'She says it is OK.' What action should the nurse take next?

• A. Clarify the client’s consent through the use of gestures and simple terms
• B. Have the interpreter co-sign the consent to validate the client's understanding
• C. Ask for a full explanation from the interpreter of the witnessed discussion
• D. Have the client sign the consent form and the nurse witness the signature

Correct answer: B

Rationale: Having the interpreter co-sign the consent form is the most appropriate action in this scenario. By having the interpreter co-sign, it ensures an additional layer of verification of the client's understanding and consent, which is crucial when language barriers exist. This step adds a level of confirmation to safeguard that the client's consent is both valid and well-informed. Option A is not sufficient as gestures and simple terms may not fully clarify the client's understanding, especially for complex medical procedures. Option C is unnecessary since the interpreter has already confirmed the client's consent. Option D does not involve the interpreter in validating the client's understanding, which is essential in this situation to ensure effective communication and comprehension between the client and the healthcare team.

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