Nursing Elites

1. You have a patient who has just had a diagnostic arthroscopy. You are instructing him about what to do when he gets home. Which of the following would you NOT instruct him to do?

• A. Resume normal activities within 12 hours so as to help reduce the swelling
• B. Elevate the extremity for 24 – 48 hours
• C. Apply ice to the area involved intermittently
• D. Report severe pain to the physician immediately

Correct answer: A

Rationale: Patients should rest and avoid normal activities for a short period after arthroscopy to allow healing and prevent swelling, which could worsen with early activity. Elevation and icing are recommended post-procedure to reduce swelling and pain. Instructing the patient to resume normal activities within 12 hours could lead to increased swelling and delayed healing. Reporting severe pain is crucial as it could indicate a complication. Therefore, the correct instruction is not to resume normal activities immediately after arthroscopy.

2. When caring for a patient with a chest tube, which nursing action is most important?

• A. Clamping the chest tube every 2 hours to prevent air leaks
• B. Keeping the drainage system below chest level
• C. Emptying the drainage system every hour to prevent backflow
• D. Removing the chest tube when drainage decreases significantly

Correct answer: B

Rationale: The most crucial nursing action when caring for a patient with a chest tube is to keep the drainage system below chest level (choice B). This position helps ensure proper drainage and prevents backflow of fluid or air into the pleural space, promoting optimal functioning of the chest tube. Clamping the chest tube every 2 hours (choice A) is incorrect as it can obstruct the drainage system and lead to complications. Emptying the drainage system every hour (choice C) is unnecessary unless there are specific clinical indications. Removing the chest tube when drainage decreases significantly (choice D) is also incorrect as the decision should be based on overall clinical assessment rather than drainage amount alone.

3. What is the correct order of steps in the nursing process?

• A. Assessment, Diagnosis, Planning, Implementation, Evaluation
• B. Planning, Implementation, Evaluation, Diagnosis, Assessment
• C. Diagnosis, Assessment, Planning, Implementation, Evaluation
• D. Implementation, Planning, Evaluation, Diagnosis, Assessment

Correct answer: A

Rationale: The correct order in the nursing process is Assessment, Diagnosis, Planning, Implementation, and Evaluation. Assessment involves gathering information about the patient, Diagnosis is identifying the problem, Planning involves setting goals and outcomes, Implementation is carrying out the plan, and Evaluation is assessing the outcomes. Choices B, C, and D have the steps in the incorrect order, not following the standard nursing process framework. Therefore, the correct answer is option A.

4. An adult female client with type 1 diabetes mellitus is receiving NPH insulin 35 units in the morning. Which finding should the PN document as evidence that the amount of insulin is inadequate?

• A. States that her feet are constantly cold and feel numb
• B. A wound on the ankle that starts to drain and becomes painful
• C. Consecutive evening serum glucose greater than 260 mg/dL
• D. Reports nausea in the morning but can still eat breakfast

Correct answer: C

Rationale: The correct answer is C. High evening glucose levels indicate that the morning dose of NPH insulin may be insufficient to control blood sugar throughout the day. Choice A is incorrect as cold and numb feet are more indicative of a circulation issue rather than an insulin inadequacy. Choice B suggests a wound infection rather than inadequate insulin. Choice D, nausea in the morning, may be due to other causes and does not necessarily indicate inadequate insulin dosage.

5. The nurse is caring for a client with pericarditis. Which of the following nursing interventions will promote comfort for the client?

• A. Auscultating the client's heart sounds
• B. Provide the client with a diversionary activity
• C. Encourage deep breathing
• D. Maintain a patent intravenous access

Correct answer: B

Rationale: Providing a diversionary activity is the most appropriate nursing intervention to promote comfort for a client with pericarditis. This intervention helps to distract the patient and reduce discomfort by focusing their attention elsewhere. Auscultating heart sounds, while important for monitoring the condition, does not directly address the client's comfort. Encouraging deep breathing can be beneficial for some conditions but may not be specifically aimed at promoting comfort in pericarditis. Maintaining a patent intravenous access is essential for treatment access and management of the condition, but it does not directly promote comfort for the client.

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