Nursing Elites

1. To prevent keratitis in an unconscious client, where should the nurse apply moisturizing ointment?

• A. Finger and toenail quicks
• B. Eyes
• C. Perianal area
• D. External ear canals

Correct answer: B

Rationale: The correct answer is B: Eyes. Applying moisturizing ointment to the eyes helps prevent keratitis, a condition that can occur due to inadequate blinking in unconscious clients, leading to corneal dryness and potential damage. Choices A, C, and D are incorrect as moisturizing ointment should not be applied to finger and toenail quicks, perianal area, or external ear canals to prevent keratitis.

2. Postoperative orders for a client undergoing a mitral valve replacement include monitoring pulmonary artery pressure together with pulmonary capillary wedge pressure with a pulmonary artery catheter. This action by the nurse will assess

• A. Right ventricular pressure
• B. Left ventricular end-diastolic pressure
• C. Acid-Base balance
• D. Coronary artery stability

Correct answer: B

Rationale: The correct answer is B: Left ventricular end-diastolic pressure. Pulmonary capillary wedge pressure is used to assess left ventricular end-diastolic pressure. This measurement provides valuable information on the filling pressure of the left ventricle. Choices A, C, and D are incorrect because monitoring pulmonary capillary wedge pressure does not directly assess right ventricular pressure, acid-base balance, or coronary artery stability.

3. The client with asthma who is sensitive to house dust-mites is being instructed by the nurse. Which information about prevention of asthma episodes would be the most helpful to include during the teaching?

• A. Change the pillow covers every month
• B. Wash bed linens in warm water with a cold rinse
• C. Wash and rinse the bed linens in hot water
• D. Use air filters in the furnace system

Correct answer: C

Rationale: The correct answer is to wash and rinse the bed linens in hot water to help eliminate dust mites, a common trigger for asthma episodes. Washing in hot water is more effective in killing dust mites compared to warm water. Changing pillow covers every month may help but is not as effective as washing bed linens in hot water. Using air filters in the furnace system may improve air quality but does not directly target dust mites on bed linens.

4. In the immediate postoperative period for a cleft lip repair in a 2-month-old infant, which nursing approach should be the priority?

• A. Remove protective arm devices one at a time for short periods with supervision
• B. Initiate oral feedings when alert
• C. Introduce the parents to the suture line cleansing protocol
• D. Position the infant on the back after feedings throughout the day

Correct answer: A

Rationale: The correct nursing approach in the immediate postoperative period for a cleft lip repair in an infant is to remove protective arm devices one at a time for short periods with supervision. This approach helps prevent injury to the surgical site while ensuring the infant's comfort and safety. Choice B is incorrect as initiating oral feedings immediately after surgery may not be appropriate and could compromise the surgical site. Choice C is incorrect as introducing parents to the suture line cleansing protocol is important but not the immediate priority. Choice D is incorrect as positioning the infant on the back after feedings is not specific to the immediate postoperative period for a cleft lip repair.

5. A child is diagnosed with poison ivy. The mother tells the nurse that she does not know how her child contracted the rash since he had not been playing in wooded areas. As the nurse asks questions about possible contact, which of the following would the nurse recognize as highest risk for exposure?

• A. Playing with toys in a backyard flower garden
• B. Eating small amounts of grass while playing 'farm'
• C. Playing with cars on the pavement near burning leaves
• D. Throwing a ball to a neighborhood child who has poison ivy

Correct answer: C

Rationale: The correct answer is C. Poison ivy can be contracted through smoke from burning plants, which can carry the urushiol oil that causes the rash. Playing near burning leaves would be the highest risk for exposure in this scenario. Choices A, B, and D do not involve direct contact with burning plants or leaves, making them lower-risk activities for exposure to poison ivy.

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