Nursing Elites

1. Which nursing action is a priority when managing a client with a wound infection?

• A. Change the wound dressing every 24 hours
• B. Perform a wound culture before administering antibiotics
• C. Cleanse the wound with alcohol-based solutions
• D. Apply a wet-to-dry dressing to the wound

Correct answer: B

Rationale: Performing a wound culture before administering antibiotics is crucial when managing a client with a wound infection. This step helps identify the specific pathogens causing the infection, allowing for the prescription of the most effective antibiotics. Changing the wound dressing every 24 hours (Choice A) is important for wound care but not the priority when an infection is present. Cleansing the wound with alcohol-based solutions (Choice C) can be too harsh and may delay wound healing. Applying a wet-to-dry dressing (Choice D) is not recommended for infected wounds as it can cause trauma to the wound bed during dressing changes.

2. A client with type 2 diabetes mellitus is concerned about weight gain during pregnancy. Which of the following responses should the nurse make?

• A. Your weight gain should be less than that for someone without diabetes.
• B. Your weight gain should be the same as that for someone without diabetes.
• C. You should not avoid gaining weight during pregnancy.
• D. You should gain more weight to support the pregnancy.

Correct answer: B

Rationale: During pregnancy, a client with type 2 diabetes mellitus should aim for a weight gain similar to someone without diabetes to ensure a healthy pregnancy. Choice A is incorrect because weight gain should not be less; it should be adequate for pregnancy. Choice C is inaccurate as gaining some weight is essential for a healthy pregnancy. Choice D is incorrect as gaining more weight than necessary can pose risks for both the client and the baby.

3. Which intervention is most important for a client with rheumatoid arthritis?

• A. Massage inflamed joints with creams and oils
• B. Provide support to flexed joints with pillows and pads
• C. Position the client on their abdomen several times a day
• D. Assist with heat application and range of motion exercises

Correct answer: D

Rationale: The most important intervention for a client with rheumatoid arthritis is to assist with heat application and range of motion exercises. Heat application helps reduce stiffness and improve joint flexibility, while range of motion exercises help maintain mobility and prevent contractures. Massaging inflamed joints with creams and oils may provide temporary relief but does not address the root cause of stiffness and limited mobility in rheumatoid arthritis. Providing support to flexed joints with pillows and pads can be helpful for comfort but does not actively promote mobility. Positioning the client on their abdomen several times a day is not a standard intervention for managing rheumatoid arthritis.

4. What are the complications of untreated fluid overload?

• A. Pulmonary edema and congestive heart failure
• B. Hypertension and electrolyte imbalance
• C. Liver failure and electrolyte imbalance
• D. Pulmonary embolism and dehydration

Correct answer: A

Rationale: Corrected Rationale: Untreated fluid overload can lead to complications such as pulmonary edema and congestive heart failure. Pulmonary edema occurs when excess fluid accumulates in the lungs, leading to difficulty breathing and potentially life-threatening respiratory distress. Congestive heart failure can result from the heart's inability to pump effectively due to the excess fluid volume, leading to symptoms such as fatigue, shortness of breath, and fluid retention. Choices B, C, and D are incorrect because hypertension, liver failure, pulmonary embolism, and dehydration are not the primary complications directly associated with untreated fluid overload.

5. A client with hypokalemia is commonly expected to present with which of the following findings?

• A. Muscle weakness
• B. Nausea
• C. Tingling sensation
• D. Increased thirst

Correct answer: A

Rationale: The correct answer is A: Muscle weakness. Hypokalemia is characterized by low potassium levels in the blood, which can lead to muscle weakness. This occurs because potassium is essential for proper muscle function, and a deficiency can impair muscle strength. Nausea (choice B) is not a typical finding associated with hypokalemia. Tingling sensation (choice C) is more commonly linked to issues like nerve damage or poor blood circulation, rather than hypokalemia. Increased thirst (choice D) is not a direct symptom of hypokalemia; it is more commonly seen in conditions like diabetes or dehydration.

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