Nursing Elites

1. Which of the following actions will most likely lead to a break in the sterile technique for respiratory isolation?

• A. Opening the patient’s window to the outside environment
• B. Turning on the patient’s room ventilator
• C. Opening the door of the patient’s room leading into the hospital corridor
• D. Failing to wear gloves when administering a bed bath

Correct answer: D

Rationale: Failure to wear gloves during a bed bath can potentially introduce pathogens, compromising the sterile technique necessary for respiratory isolation. Proper hand hygiene and personal protective equipment are crucial to prevent the transmission of infectious agents in such settings.

2. During discharge teaching, a client informs the nurse about a new prescription for prednisone for asthma. Which of the following client statements indicates an understanding in teaching?

• A. I will decrease my fluid intake while taking this medication.
• B. I will expect to have black, tarry stools.
• C. I will take my medication with meals.
• D. I will monitor for weight loss while on this medication.

Correct answer: C

Rationale: Taking prednisone with meals can help reduce the risk of gastrointestinal upset and irritation. It is important for the client to understand how to take the medication correctly to maximize its effectiveness and minimize potential side effects. Monitoring for weight loss or changes in stools may be important but does not directly relate to the administration of the medication with meals.

3. A client has unilateral paralysis and dysphagia following a right hemispheric stroke. Which of the following interventions should the nurse include in the plan?

• A. Place the client's left arm on a pillow while he is sitting.
• B. Provide total care in assisting with the client's ADLs.
• C. Encourage mobility and avoid bed rest.
• D. Facilitate feeding by placing food on the left side of the client's mouth when ready to eat.

Correct answer: A

Rationale: Placing the client's left arm on a pillow while sitting helps prevent shoulder displacement and assists in maintaining proper positioning and alignment. This intervention is crucial to prevent complications associated with immobility. Providing total care in ADLs may hinder the client's independence and recovery. Encouraging mobility is essential in preventing complications of immobility. Facilitating feeding by placing food on the unaffected side of the mouth helps reduce the risk of aspiration in clients with dysphagia.

4. Which of the following vascular system changes result from aging?

• A. Increased peripheral resistance of the blood vessels
• B. Decreased blood flow
• C. Increased workload of the left ventricle
• D. All of the above

Correct answer: D

Rationale: As individuals age, various changes occur in the vascular system. These changes include increased peripheral resistance of the blood vessels, decreased blood flow, and an increased workload of the left ventricle. Therefore, all the listed changes result from aging, making option D, 'All of the above,' the correct answer.

5. For a rectal examination, the patient can be directed to assume which of the following positions?

• A. Genupectoral
• B. Sims
• C. Horizontal recumbent
• D. All of the above

Correct answer: B

Rationale: The correct position for a rectal examination is the Sims position, where the patient lies on their left side with the upper knee flexed. This position allows for easy access and visualization of the rectal area for examination.

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