Nursing Elites

1. Which is the proper hand position for performing chest vibration?

• A. cup the hands
• B. use the side of the hands
• C. flatten the hands
• D. spread the fingers of both hands

Correct answer: C

Rationale: The correct hand position for performing chest vibration is to flatten the hands. By flattening the hands over the area of the body where chest percussion is applied, vibrations can be conducted effectively to the chest to help loosen secretions. Cupping the hands may dampen vibrations, using the side of the hands reduces the surface area in contact with the chest, and spreading the fingers can lead to uneven pressure distribution. Therefore, flattening the hands provides the necessary contact and surface area to perform chest vibration efficiently.

2. Which of the following devices may be applicable to a bedridden patient to address potential venous insufficiency?

• A. Shear-reducing mattress
• B. Sequential compression devices
• C. Hiking stockings
• D. Non-skid socks

Correct answer: B

Rationale: For a bedridden patient with potential venous insufficiency, sequential compression devices (SCDs) and compression stockings are appropriate choices. SCDs help improve venous return from the lower extremities by applying sequential pressure, aiding circulation. Compression stockings also assist in preventing blood from pooling in the legs by applying pressure to support venous return. Shear-reducing mattresses are not directly related to managing venous insufficiency, as they are designed to reduce friction and shear forces on the skin to prevent pressure ulcers. Non-skid socks are primarily used for fall prevention and have no direct impact on venous insufficiency.

3. Which of the following statements by a client indicates adequate understanding of preparation for a lipoprotein fractionation test?

• A. "I cannot eat or drink after midnight."?
• B. "I cannot eat for 12 hours before the test."?
• C. "I need to limit my fluid intake."?
• D. "I need to ingest a lipid solution."?

Correct answer: B

Rationale: The correct statement regarding preparation for a lipoprotein fractionation test is that the client cannot eat for 12 hours before the test. It is important to note that the client can drink an unrestricted amount of water. Limiting fluid intake is not necessary for this test. There is no need for the client to ingest a lipid solution as part of the preparation. Therefore, the other choices are incorrect.

4. The advanced directive in a client's chart is dated August 12, 1998. The client's daughter produces a Power of Attorney for Health Care, dated 2003, which contains different care directions. What should the nurse do?

• A. Follow the 1998 version because it's part of the legal chart.
• B. Follow the 1998 version because the physician's code order is based on it.
• C. Follow the 2003 version, place it in the chart, and communicate the update appropriately.
• D. Follow neither until clarified by the unit manager.

Correct answer: C

Rationale: The document dated 2003 supersedes the previous version and should be used as a basis for care directions. The nurse should follow the 2003 version, place it in the chart, and communicate the update appropriately to ensure that the most current care directions are followed. Choices A and B are incorrect because the 1998 version is now outdated, and the nurse should not rely on it for care decisions. Choice D is incorrect because the nurse should not delay following the updated document, and seeking clarification from the unit manager can lead to avoidable delays in care.

5. Which of the following syndromes associated with incomplete lesions of the spinal cord results from damage to one-half of the spinal cord?

• A. Brown-S�quard syndrome
• B. posterior cord syndrome
• C. central cord syndrome
• D. cauda equina syndrome

Correct answer: A

Rationale: Brown-S�quard syndrome is indeed associated with incomplete lesions of the spinal cord, and it specifically results from damage to one-half of the spinal cord. This syndrome manifests as ipsilateral motor paralysis, ipsilateral loss of vibration and proprioception, and contralateral loss of pain and temperature sensation. Posterior cord syndrome mainly involves the loss of proprioception and vibratory sense, while sparing motor function and pain sensation. Central cord syndrome typically presents with more weakness in the upper extremities compared to the lower extremities due to central spinal cord damage. Cauda equina syndrome affects the nerve roots at the level of the conus medullaris, leading to symptoms like lower extremity weakness, numbness, and bowel/bladder dysfunction.

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