Nursing Elites

1. Which of the following statements by a client with gastroesophageal reflux disease (GERD) indicates adequate understanding?

• A. "I should eat right before bedtime."?
• B. "I should eat large meals."?
• C. "I should sit up after eating."?
• D. "I should lie flat after eating."?

Correct answer: C

Rationale: The correct statement for a client with GERD is, 'I should sit up after eating.' This helps prevent reflux by keeping the stomach contents down. Choice A is incorrect as eating right before bedtime can exacerbate GERD symptoms by increasing the likelihood of reflux during the night. Choice B is incorrect because consuming large meals can lead to increased stomach pressure and worsen reflux symptoms. Choice D is incorrect because lying flat after eating can promote reflux due to gravity assisting the flow of stomach contents into the esophagus, worsening GERD.

2. A nurse is reviewing the notes written by a nurse on a previous shift. Which note in the client's record reflects the correct use of guidelines for documentation?

• A. The client's wound is healing well.
• B. The client seems anxious.
• C. The client's intake was 360 mL
• D. The client is voiding large amounts

Correct answer: C

Rationale: Quality documentation and reporting require information to be factual, accurate, complete, current, and organized. Choice C, 'The client's intake was 360 mL,' reflects the correct use of guidelines for documentation as it provides a specific and measurable observation. This note meets the criteria for quality documentation by being specific and quantifiable. Choices A, B, and D lack specificity and quantifiability. Choice A includes a subjective term 'well,' choice B uses 'seems' indicating uncertainty, and choice D uses a vague term 'large' without quantifying the amount.

3. The LPN is receiving the report on a comatose client at the start of the shift at 1500. What statement should be of most concern?

• A. The client was repositioned on his right side at 1100.
• B. The client was bathed, and the skin was assessed head-to-toe at 0900 with no abnormal findings.
• C. The client's PEG tube was changed 6 months ago.
• D. The client's indwelling urinary catheter was last changed 5 days ago.

Correct answer: D

Rationale: When caring for a comatose client, it is crucial to monitor and maintain the integrity of the indwelling urinary catheter to prevent urinary tract infections and other complications. Changing the urinary catheter less frequently than recommended increases the risk of infection. In this scenario, the most concerning issue is the prolonged duration since the last change of the indwelling urinary catheter, which poses an immediate risk to the client's health. While repositioning every 2 hours is essential to prevent skin breakdown, the most critical aspect in this case is the catheter care. Bathing and skin assessment are important for overall hygiene and skin integrity but are not as urgent as catheter care. The timing of the PEG tube change, while relevant for care planning, is not as immediate a concern as the indwelling urinary catheter status.

4. An example of a process standard on a med-surg unit is:

• A. a procedure for changing IV tubing.
• B. a policy for staffing.
• C. the job description of the CEO (chief executive officer).
• D. a procedure for checking waveforms on a client being treated with an intra-aortic balloon pump.

Correct answer: D

Rationale: Process standards define the actions and behaviors required by staff to provide care on a med-surg unit. A procedure for changing IV tubing is a critical psychomotor skill necessary for safe and effective patient care in this setting. Choice B, a policy for staffing, pertains more to organizational management rather than specific care processes on the unit. Choice C, the job description of the CEO, delineates the responsibilities of the organization's top executive and is not a process standard for frontline staff. Choice D, a procedure for checking waveforms on a client with an intra-aortic balloon pump, is more specific to a cardiac care unit and not typically performed on a med-surg unit.

5. An advance directive is written and notarized according to law in the state of Colorado. This document is legal and binding:

• A. internationally.
• B. in the state of Colorado only.
• C. in the continental United States.
• D. in the county of origination only.

Correct answer: B

Rationale: The correct answer is 'in the state of Colorado only.' Advance directive protocols and documents are specific to each state's laws and regulations. Choice A is incorrect as advance directives are not universally recognized internationally. Choice C is incorrect as the legal validity of an advance directive is limited to the state in which it was created. Choice D is incorrect as the legal reach of an advance directive typically extends throughout the state of origination, not just the county.

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