Nursing Elites

1. When a client has suffered severe burns all over his body, the most effective method of monitoring the cardiovascular system is:

• A. Cuff blood pressure.
• B. Arterial pressure.
• C. Pulmonary artery pressure.
• D. Central venous pressure.

Correct answer: D

Rationale: Central venous pressure (CVP) monitoring is the most effective method to assess fluid status and the cardiovascular system in a client with severe burns. Severe burns can lead to significant fluid shifts and hemodynamic changes, making central venous pressure monitoring crucial for guiding fluid resuscitation and managing cardiovascular stability in these patients.

2. The client is being taught how to self-administer a subcutaneous injection. To ensure sterility of the procedure, which subject is most important for the instructor to include in the teaching plan?

• A. Hand washing before preparing the injection.
• B. Technique for drawing medication from a vial.
• C. Selection and rotation of injection sites.
• D. Proper disposal of injection equipment.

Correct answer: B

Rationale: To maintain the sterility of the procedure, it is crucial to teach the client the correct technique for drawing medication from a vial. This ensures that the medication remains sterile during preparation and administration. While hand washing, injection site selection, and equipment disposal are important aspects of injection safety, the key focus should be on maintaining the sterility of the medication itself to prevent infections and ensure the effectiveness of the treatment.

3. A high school senior is complaining of a persistent cough and admits to smoking 10 to 15 cigarettes daily for the past year. He is convinced that he is hopelessly addicted to tobacco since he tried unsuccessfully to quit smoking last week. Which intervention is best for the nurse to implement?

• A. Encourage the student to associate with non-smokers only while attempting to stop smoking.
• B. Tell the student that he is still young and should continue trying various smoking cessation methods.
• C. Describe cigarette smoking as a habit that requires a strong will to overcome its addictiveness.
• D. Provide the student with the latest research data describing the long-term effects of tobacco use.

Correct answer: A

Rationale: Adolescents are particularly influenced by peers, so associating with non-smokers may help the student quit smoking. By being surrounded by non-smokers, the student is less likely to feel pressured to smoke and may be encouraged to adopt healthier behaviors. This intervention leverages the power of social influence to support smoking cessation efforts and create a more conducive environment for the student to quit smoking. Choices B, C, and D do not address the social aspect of smoking behavior and the influence of peers on smoking habits, making them less effective interventions in this case.

4. The healthcare provider is caring for a client diagnosed with type 2 diabetes mellitus. Which intervention should the healthcare provider implement to assess the client’s glycemic control?

• A. Monitor fasting blood glucose levels
• B. Check urine for ketones
• C. Evaluate hemoglobin A1c levels
• D. Assess the client’s dietary intake

Correct answer: C

Rationale: Evaluating hemoglobin A1c levels is the most appropriate intervention to assess glycemic control in a client with type 2 diabetes mellitus. Hemoglobin A1c levels reflect the average blood glucose control over the past 2-3 months, providing valuable information for monitoring and managing diabetes. Monitoring fasting blood glucose levels (Choice A) is important for daily management but does not provide a long-term view like hemoglobin A1c. Checking urine for ketones (Choice B) is more relevant for assessing diabetic ketoacidosis. Assessing dietary intake (Choice D) is crucial for overall diabetes management but does not directly assess glycemic control.

5. At 0100 on a male client’s second postoperative night, the client states he is unable to sleep and plans to read until feeling sleepy. What action should the nurse implement?

• A. Leave the room and close the door to the client’s room
• B. Assess the appearance of the client’s surgical dressing
• C. Bring the client a prescribed PRN sedative-hypnotic
• D. Discuss symptoms of sleep deprivation with the client

Correct answer: A

Rationale: The client has expressed a plan to read until feeling sleepy, indicating that he is managing his inability to sleep. In this situation, it is best for the nurse to respect the client's autonomy and leave the room, providing privacy and an opportunity for the client to relax and hopefully fall asleep. Closing the door can also help create a quiet environment conducive to rest.

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