Nursing Elites

1. The nurse will be using the Braden Scale with each admit to the long-term care center. Which of these will NOT be utilized in a Braden Scale Assessment?

• A. Mental state
• B. Friction and shear
• C. Nutrition
• D. Sensory perception

Correct answer: A

Rationale:

2. A nurse is caring for an immobile client. What is the priority assessment of this client?

• A. Palpate for edema
• B. Auscultate for bowel sounds
• C. Inspect the skin for injury
• D. Auscultation of lung sounds

Correct answer: C

Rationale: Inspecting the skin for injury is crucial to prevent pressure ulcers and other complications in immobile clients.

3. The nurse uses proper body mechanics to move a client up in bed. What action by the nurse will increase their risk of a workplace injury?

• A. Place the bed in the lowest possible position
• B. Use the legs when lifting
• C. Keep feet apart to provide a wide base of support
• D. Face the direction of the movement

Correct answer: A

Rationale: Placing the bed in the lowest possible position increases the risk of injury because it does not support proper body mechanics. When lifting a client, it is important to have the bed at a comfortable height to avoid strain. Using the legs when lifting (choice B) is correct as it reduces the strain on the back. Keeping feet apart to provide a wide base of support (choice C) helps with stability and balance. Facing the direction of the movement (choice D) is essential for maintaining proper alignment and reducing the risk of injury.

4. The nurse is providing education to a client regarding the administration of eye drops. Which of the following actions indicates the need for further client education?

• A. The client instills the prescribed number of eye drops into the conjunctival sac
• B. The client sets the cap to the eye drop container down in a manner that does not contaminate it
• C. The client touches the administration dropper her to the eye
• D. The client washes her hands before instilling the eye drops

Correct answer: C

Rationale:

5. A client has a fractured right arm. What should the nurse do first?

• A. Apply ice to the fracture site
• B. Administer pain medications
• C. Remove the client’s bracelet and rings from the right arm
• D. Send the client to radiology for an x-ray

Correct answer: C

Rationale: The nurse should first remove the client's bracelet and rings from the right arm. This action is crucial to prevent complications such as swelling and restricted blood flow, which could worsen the condition. Applying ice, administering pain medications, and sending the client for an x-ray are important steps but should come after ensuring the client's jewelry is removed to avoid any further issues.

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