Nursing Elites

1. Which of these devices is considered a protective device, rather than a restraint?

• A. A mitten on the hands to prevent scratching
• B. A mitten on the hands to prevent the person from pulling their IV out
• C. A side rail to prevent the patient from falling
• D. A soft wrist restraint to prevent the patient from pulling their IV tubing

Correct answer: A

Rationale: A mitten on the hands to prevent scratching is considered a protective device because its primary purpose is to protect the patient from harming themselves by scratching. It does not restrict the patient's movement. Choice B, a mitten on the hands to prevent the person from pulling their IV out, is considered a restraint as it limits the patient's movement. Choice C, a side rail to prevent the patient from falling, is also a protective device as it aims to keep the patient safe by providing support and preventing falls. Choice D, a soft wrist restraint to prevent the patient from pulling their IV tubing, is a type of restraint as it restricts the patient's movement to prevent them from interfering with medical equipment.

2. An assisted living facility is an example of which type of healthcare provider?

• A. Primary care
• B. Secondary care
• C. Tertiary care
• D. None of the above

Correct answer: C

Rationale: An assisted living facility is an example of a tertiary care provider. Tertiary care providers offer specialized services such as rehabilitation, long-term care, and management of complex medical conditions. These services are typically provided after primary and secondary care interventions. Choice A, primary care, focuses on preventive care and routine medical treatment for common illnesses, which is not the level of care provided by assisted living facilities. Choice B, secondary care, involves specialized medical services provided by medical specialists and hospitals for conditions that require a higher level of expertise than primary care, but it is not the level of care provided by assisted living facilities. Choice D, None of the above, is incorrect as assisted living facilities fall under the category of tertiary care providers.

3. Mobility is an important human function. The hazards of immobility lead to many physical and emotional problems. Immobility can lead to detrimental cardiac, muscular, respiratory, skeletal, urinary, gastrointestinal, skin, and emotional changes. Which of the following is an example of a skeletal hazard of immobility?

• A. Contractures.
• B. Constipation.
• C. Calcium loss.
• D. Catabolism.

Correct answer: C

Rationale: All choices are hazards of immobility, but only calcium loss from the bones is a skeletal system impairment that results from immobility. Contractures are muscle shortening due to prolonged positioning, which affects the muscular system. Constipation is a gastrointestinal issue. Catabolism is a metabolic process, not specific to the skeletal system.

4. Albert B. is incontinent of urine. He also wears glasses and hearing aids. His ____________lead(s) to his risk for falls.

• A. incontinence and loss of vision
• B. loss of vision
• C. incontinence
• D. loss of hearing

Correct answer: B

Rationale: Albert B. is at risk for falls due to two factors: his incontinence and his loss of vision. Loss of vision significantly impairs one's ability to navigate and avoid obstacles, thereby increasing the risk of falls. While incontinence is a risk factor for falls, the primary concern in this case is the loss of vision since it directly affects balance and safety. Therefore, the correct answer is 'loss of vision.' Choices A, C, and D are incorrect because they do not address the key factor of impaired vision leading to the risk of falls.

5. A client is preparing to undergo a cystoscopy for stones. Which of the following statements indicates that the client understands the procedure?

• A. I better drink a lot of fluid now because I won't be able to after the test.
• B. I will probably see a little blood when I urinate.
• C. I will be able to go home after 3 days in the hospital.
• D. I won't need any pain medicine; this probably will not hurt.

Correct answer: B

Rationale: The correct answer is, 'I will probably see a little blood when I urinate.' During a cystoscopy, a scope is inserted into the client's bladder to inspect structures or remove objects like stones. This procedure is usually performed under local or general anesthesia. It is common for clients to experience a small amount of blood in their urine (hematuria) or have pink-colored urine after the procedure. The other choices are incorrect because drinking a lot of fluid before the test, staying in the hospital for 3 days, and assuming no pain will be experienced are not accurate statements related to a cystoscopy procedure.

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