Nursing Elites

1. A nurse is providing discharge instructions for a client who had back surgery. All of the following indicate that the client is ready for discharge EXCEPT:

• A. The client still has sutures at the incision site
• B. The client is able to take a shower
• C. The client must still use an ice pack at the wound site
• D. The client has a temperature of 100.8�F

Correct answer: D

Rationale: When determining if a client is ready for discharge after back surgery, it is essential to ensure that there are no signs of complications or emerging issues. A postoperative temperature of 100.8�F may indicate a developing infection, and the client should not be discharged until this is further evaluated by the physician. Choices A, B, and C are indicators that the client is progressing well and ready for discharge, as having sutures, being able to shower, and using an ice pack are typically expected postoperative activities without indicating a need for further hospitalization.

2. In a clinic in a primarily African American community, a higher incidence of uncontrolled hypertension is noted in patients. To correct this health disparity, what should the nurse do first?

• A. Initiate a regular home-visit program by clinic nurses.
• B. Schedule teaching sessions about low-salt diets at community events.
• C. Assess the perceptions of community members about the care at the clinic.
• D. Obtain low-cost antihypertensive drugs using government grant funding.

Correct answer: C

Rationale: To address the higher incidence of uncontrolled hypertension in the primarily African American community, the nurse should first assess the perceptions of community members about the care at the clinic. Understanding the community's perspective can provide valuable insights into the reasons behind the health disparity. Initiating a regular home-visit program or scheduling teaching sessions about low-salt diets are important interventions but should come after gathering information on community perceptions. Obtaining low-cost antihypertensive drugs is not the initial priority; understanding community perspectives is crucial for developing effective interventions.

3. A woman has died as a result of a motor vehicle accident. She is listed as an organ donor, and her family is considering whether to comply with her wishes. Which of the following is true?

• A. The woman would have had to list herself as an organ donor and notify her family before her death that she has considered donating her organs.
• B. The Uniform Anatomical Gift Act requires the physician caring for the patient to inform the family who receives the donor organs.
• C. Physicians can choose to go against the deceased's wishes if the family decides that organ donation is not an acceptable choice.
• D. Physicians have the legal responsibility to inform patients of the risks involved in donating organs.

Correct answer: D

Rationale: In cases where a deceased person is listed as an organ donor, the family may have the final say on whether to proceed with organ donation, even if the individual had expressed their wish to donate. Physicians may prioritize the emotional well-being of the family over the wishes of the deceased, especially if organ donation could cause additional distress or trauma to the grieving family members. Therefore, it is possible for physicians to respect the family's decision not to proceed with organ donation, even if the deceased had previously expressed the desire to donate. This decision-making process underscores the importance of considering and respecting the perspectives and emotions of both the deceased individual and their surviving family members in organ donation scenarios.

4. How can the dangers associated with wandering in Alzheimer's disease patients be prevented?

• A. Bed alarms
• B. Chair alarms
• C. Door alarms
• D. All of the above

Correct answer: D

Rationale: The correct answer is 'All of the above.' Bed alarms, chair alarms, and door alarms are all effective measures to prevent the dangers associated with wandering in Alzheimer's disease patients. These alarms can alert caregivers when a patient tries to leave a designated area, helping to keep them safe. It is crucial to respond promptly to these alarms to ensure the patient's safety. Choices A, B, and C are incorrect individually as each type of alarm plays a vital role in a comprehensive wandering prevention strategy.

5. While caring for a client in labor, a nurse attaches an electronic fetal monitor to the client's abdomen to assess the baby's heart rate. The nurse observes that the baby's heart rate slows down during each contraction and does not return to normal limits until after the contraction is complete. What type of fetal heart rate change does this pattern describe?

• A. Variable decelerations
• B. Late decelerations
• C. Early decelerations
• D. Accelerations

Correct answer: B

Rationale: Late decelerations are characterized by the baby's heart rate declining in utero during contractions. The heart rate drops below baseline and stays low until after the contraction ends. Late decelerations are concerning as they indicate uteroplacental insufficiency, which can compromise fetal oxygenation. This pattern is a non-reassuring sign and requires immediate intervention. Variable decelerations are typically abrupt decreases in heart rate, often associated with cord compression. Early decelerations, on the other hand, mirror the contractions and are considered benign, resulting from fetal head compression. Accelerations are reassuring signs of fetal well-being, indicating a responsive and healthy fetal nervous system.

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