Nursing Elites

1. A 45-year-old client with type I diabetes is in need of support services upon discharge from a skilled rehabilitation unit. Which of the following services is an example of a skilled support service?

• A. shopping for groceries
• B. house cleaning
• C. transportation to physician's visits
• D. medication instruction

Correct answer: D

Rationale: The correct answer is medication instruction. This is a skilled service that requires specialized knowledge and training to provide proper guidance on medication management for a client with type I diabetes. Grocery shopping, house cleaning, and transportation services are considered unskilled services as they are typically offered by volunteer or fee-for-service agencies and do not require specialized medical expertise. Medication instruction, on the other hand, involves educating the client on how to properly take medications, understand potential side effects, and manage their medication regimen effectively, which necessitates a high level of expertise and training.

2. When preparing to listen to a client's breath sounds, what technique should a nurse use?

• A. Ask the client to sit and lean forward slightly, with the arms resting comfortably across the lap.
• B. Listen to the right lung first, then the left lung, moving from top to bottom systematically.
• C. Ask the client to take deep breaths through the mouth.
• D. Use the diaphragm of the stethoscope, holding it firmly against the client's chest.

Correct answer: D

Rationale: When preparing to listen to a client's breath sounds, a nurse should ask the client to sit and lean forward slightly, with the arms resting comfortably across the lap. The client should be instructed to breathe through the mouth a little more deeply than usual but to stop if feeling dizzy. The nurse should use the flat diaphragm end-piece of the stethoscope, holding it firmly on the chest wall. By using the diaphragm, the nurse can listen for at least one full respiration in each location, moving from side to side to compare sounds. This technique ensures a systematic and thorough assessment of lung sounds. Choice A is correct as it includes the proper positioning of the client and specifies the use of the diaphragm of the stethoscope. Choice B is incorrect as both lungs should be auscultated systematically, starting from the top and moving down. Choice C is incorrect as deep breaths, not shallow ones, are recommended for an accurate assessment of breath sounds.

3. According to Erikson, which developmental task is a toddler confronting when they develop 'a will of his own' and 'acts as if he can control others'?

• A. Trust versus mistrust
• B. Autonomy versus doubt and shame
• C. Initiative versus guilt
• D. Industry versus inferiority

Correct answer: B

Rationale: According to Erikson, the correct developmental task for a toddler who has developed 'a will of his own' and 'acts as if he can control others' is Autonomy versus doubt and shame. Toddlers at this stage are asserting their wills and realizing they can control others, which is part of developing autonomy. However, they may also experience doubt and shame if their assertiveness is met with disapproval. Trust versus mistrust is the developmental task of the infant, where the main focus is on developing trust in the caregiver. Initiative versus guilt is the developmental task of the preschool-age child, emphasizing the balance between taking initiative and feeling guilty. Industry versus inferiority is the developmental task of the school-age child, focusing on competence and self-esteem.

4. How often should the nurse change the intravenous tubing on total parenteral nutrition solutions?

• A. every 24 hours
• B. every 36 hours
• C. every 48 hours
• D. every 72 hours

Correct answer: A

Rationale: The correct answer is 'every 24 hours.' Changing the intravenous tubing on total parenteral nutrition solutions every 24 hours is crucial due to the high risk of bacterial growth. Bacterial contamination can lead to serious infections in patients receiving total parenteral nutrition. Choices B, C, and D are incorrect because waiting longer intervals between tubing changes increases the risk of bacterial contamination and infection, compromising patient safety. It is essential to maintain a strict 24-hour schedule to minimize the risk of complications associated with bacterial contamination.

5. When administering a nasal spray medication, what should the client do before the medication is administered?

• A. The client should blow their nose gently before the medication is administered.
• B. The medication should be sprayed into the nostril.
• C. The medication should be administered as the client inhales.
• D. The client should sit upright when the medication is administered.

Correct answer: A

Rationale: The correct answer is that the client should blow their nose gently before the medication is administered. This step helps clear the nasal passages, ensuring that the medication can reach its intended target. Choice B is incorrect as the nasal spray should be directed into the nostril, not just in front of the nose. Administering the medication as the client inhales (Choice C) is crucial to ensure proper delivery, as it helps the medication reach the desired areas. Choice D is incorrect because the client should be sitting upright, not lying flat, when administering nasal spray medication to allow for better absorption and prevent the medication from flowing out.

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