Nursing Elites

1. When preparing a client for surgery, the graduate nurse realizes the operative permit has not been signed. The client tells the nurse he understands the procedure but received his preoperative medication approximately 10 minutes prior. The appropriate action would be:

• A. Have the client sign the permit, as he verbalizes understanding.
• B. Witness the form after having the client sign it.
• C. Have his wife sign the form as she witnessed him saying he wants the surgery.
• D. Call the surgical area and explain the surgery will have to be cancelled.

Correct answer: D

Rationale: The correct action in this scenario is to call the surgical area and explain that the surgery will have to be cancelled. The client must sign the operative permit or any other legal document before receiving preoperative medication. Without the signed permit, the surgery cannot proceed to ensure the client's safety and legal compliance. Having the client sign the permit, witnessing the form after the client signs it, or having someone else sign the form are all inappropriate actions and do not address the legal requirement of the client's signature before receiving preoperative medication.

2. A pregnant client is being educated by a nurse on nutrition and foods rich in folic acid. Which food item does the nurse inform the client contains the highest amount of folic acid?

• A. Pinto beans
• B. Lettuce
• C. Oranges
• D. Broccoli

Correct answer: A

Rationale: Pinto beans contain the highest amount of folic acid among the options provided, with 294 mcg per 1-cup serving. Oranges contain 44 mcg per 1-cup serving, lettuce contains 60 mcg per 1-cup serving, and broccoli contains 78 mcg per 1-cup serving. Therefore, pinto beans are the best choice for increasing folic acid intake during pregnancy. Choosing oranges, lettuce, or broccoli would not provide as much folic acid compared to pinto beans, making them less optimal choices for meeting folic acid requirements during pregnancy.

3. A pregnant client asks how she can prevent getting Group B Strep. What is the LPN's best response?

• A. You cannot prevent getting Group B Strep; you can only treat it.
• B. You should have your partner wear a condom every time you have intercourse.
• C. You should be extra vigilant about hand-washing, especially in the third trimester.
• D. The Group B Strep vaccine is the only proven way to prevent the disease.

Correct answer: A

Rationale: The best response for the LPN to provide to a pregnant client concerned about preventing Group B Strep is that it cannot be prevented, only treated. Group B Strep is a normal flora found in the vagina, rectum, and intestines of about 25% of women and is not a sexually transmitted disease. Testing for Group B Strep is done in each pregnancy, usually around 35-37 weeks. If a woman tests positive, antibiotics are administered during labor to reduce the risk of complications for both the mother and the baby. Choice A is the correct answer as Group B Strep cannot be prevented but only treated. Choice B is incorrect; condom use does not prevent Group B Strep. Choice C is not the best response as hand-washing is important for general hygiene but does not specifically prevent Group B Strep. Choice D is incorrect as there is no vaccine available to prevent Group B Strep.

4. A 65-year-old female client is experiencing postmenopausal bleeding. Which type of physician should this client be encouraged to see?

• A. a radiologist
• B. a gynecologist
• C. a physiatrist
• D. an oncologist

Correct answer: B

Rationale: A gynecologist is the appropriate physician for this scenario as they specialize in treating and managing diseases of the female reproductive system, including postmenopausal bleeding. Postmenopausal bleeding can indicate serious conditions such as endometrial cancer, which a gynecologist can evaluate and manage. A radiologist primarily evaluates X-rays and imaging studies, not directly involved in managing gynecological issues. A physiatrist is a specialist in physical medicine and rehabilitation, not related to gynecological concerns. An oncologist specializes in diagnosing and treating cancer, which is not the primary concern in this case of postmenopausal bleeding.

5. After breast reconstruction secondary to breast cancer, the nurse should recognize which of the following expected client outcomes as evidence of a favorable response to nursing interventions related to disturbed body image?

• A. maintaining adequate tissue perfusion
• B. demonstrating behaviors that reduce fears
• C. restored body integrity
• D. remaining free of infection

Correct answer: C

Rationale: The correct answer is 'restored body integrity.' This outcome is crucial in addressing disturbed body image following breast reconstruction. Restored body integrity reflects a positive perception of one's body after surgery, contributing to improved body image. Choices A, 'maintaining adequate tissue perfusion,' are more related to physiological outcomes and are not directly linked to body image concerns. Choice B, 'demonstrating behaviors that reduce fears,' is associated with anxiety management, not body image. Choice D, 'remaining free of infection,' pertains to preventing infections and does not directly address body image concerns.

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