Nursing Elites

1. When administering an analgesic to a client with low back pain, which intervention should the practical nurse implement to promote the effectiveness of the medication?

• A. Massage the lower back and position the client in proper alignment
• B. Encourage the client to ambulate frequently and take deep breaths
• C. Assist the client in performing passive and active range of motion exercises
• D. Give medication with a full glass of water and offer high-fiber foods

Correct answer: A

Rationale: Massaging the lower back and positioning the client in proper alignment can help relieve muscle tension and enhance the effectiveness of analgesics by providing additional comfort and promoting better pain management. This intervention directly addresses the site of pain and can improve the medication's efficacy. Choices B, C, and D are incorrect because while they may have benefits in other situations, they are not directly related to promoting the effectiveness of analgesics in clients with low back pain. Encouraging ambulation and deep breathing, assisting with range of motion exercises, and offering water and high-fiber foods are important for overall patient care but are not specific to enhancing analgesic effectiveness in this context.

2. A client on bedrest refuses to wear the prescribed pneumatic compression devices after surgery. Which action should the PN implement in response to the client's refusal?

• A. Emphasize the importance of active foot flexion
• B. Check the surgical dressing
• C. Complete an incident report
• D. Explain the use of an incentive spirometer every 2 hours

Correct answer: A

Rationale: The correct action for the PN to implement when a client refuses pneumatic compression devices is to emphasize the importance of active foot flexion. Active foot flexion exercises can help prevent deep vein thrombosis (DVT) in clients who are not using the compression devices. Encouraging some form of circulation-promoting activity is crucial to reduce the risks associated with immobility. Checking the surgical dressing (Choice B) is important but not the immediate action to address the refusal of compression devices. Completing an incident report (Choice C) is not necessary in this situation as the client's refusal is not an incident. Explaining the use of an incentive spirometer (Choice D) is not directly related to addressing the refusal of compression devices for DVT prevention.

3. The PN observes a UAP preparing to exit a client's room. The UAP's hands appear visibly soiled as the UAP uses a hand rub for 19 seconds to cleanse the hands. Which action should the PN take?

• A. Confirm that the UAP completed hand hygiene correctly
• B. Instruct the UAP to wash the hands for one minute
• C. Ask the UAP why the hands were so obviously soiled
• D. Advise the UAP to use the hand rub for 30 seconds

Correct answer: D

Rationale: When hands are visibly soiled, they should be washed with soap and water for at least 20 seconds. However, when using hand rub, it should be applied for at least 30 seconds to be effective. In this scenario, the UAP's hands were visibly soiled, indicating the need for thorough cleaning. Advising the UAP to use the hand rub for 30 seconds is essential to ensure proper hand hygiene and reduce the risk of spreading infection. Choices A, B, and C are incorrect because confirming completion of hand hygiene, instructing to wash for one minute, or asking why the hands were soiled do not address the immediate need for proper hand hygiene in the given situation.

4. An adult female client with type 1 diabetes mellitus is receiving NPH insulin 35 units in the morning. Which finding should the nurse document as evidence that the amount of insulin is inadequate?

• A. States that her feet are constantly cold and numb
• B. A wound on the ankle that starts to drain and becomes painful
• C. Consecutive evening serum glucose greater than 260 mg/dL
• D. Reports nausea in the morning but still able to eat breakfast

Correct answer: C

Rationale: The correct answer is C. Consistently high evening glucose levels indicate that the current insulin dosage is inadequate to maintain proper glucose control. Choice A is incorrect because cold and numb feet are more indicative of peripheral vascular disease rather than inadequate insulin dosage. Choice B describes a wound that may be related to poor circulation or neuropathy but not necessarily inadequate insulin dosage. Choice D suggests gastrointestinal issues that are not directly related to insulin dosage adequacy.

5. How does the home care nurse determine that a 78-year-old client is unable to remain in his current residence alone?

• A. The goals set by the client
• B. The learning level of the client
• C. Assessing the home environment
• D. The distractions in the client's home

Correct answer: C

Rationale: The correct answer is assessing the home environment. This process is vital in evaluating whether an elderly client can safely live independently. Factors like safety hazards and the client's ability to handle daily activities are considered during this assessment. Choices A, B, and D are incorrect because determining the client's ability to remain in his residence alone relies more on evaluating the home environment for safety and suitability rather than the client's goals, learning level, or distractions in the home.

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