Nursing Elites

1. When discussing clients designating a health care proxy in situations requiring a durable power of attorney for health care (DPAHC), what information should the charge nurse include?

• A. The proxy should make health care decisions for the client regardless of the client's ability to do so.
• B. The proxy can make financial decisions if the need arises.
• C. The proxy can make treatment decisions if the client is under anesthesia.
• D. The proxy should manage legal issues for the client.

Correct answer: C

Rationale: The correct answer is C. The charge nurse should include information that the proxy can make treatment decisions if the client is under anesthesia. This is a key function of a durable power of attorney for health care. Choices A, B, and D are incorrect because a health care proxy's role is specifically related to making health care decisions, not financial decisions, legal issues, or decisions made under anesthesia.

2. A client has a new prescription for digoxin. Which of the following instructions should the nurse include?

• A. Take this medication with food to prevent nausea.
• B. Notify your provider if you experience visual disturbances.
• C. Take an antacid with this medication if indigestion occurs.
• D. Avoid taking this medication if your heart rate is less than 60/min.

Correct answer: B

Rationale: The correct instruction for a client taking digoxin is to notify their provider if they experience visual disturbances. Visual disturbances can be a sign of digoxin toxicity, and prompt notification to the healthcare provider is essential for timely intervention. Choice A is incorrect because digoxin should be taken on an empty stomach for better absorption. Choice C is incorrect because antacids can interfere with the absorption of digoxin. Choice D is incorrect because a heart rate less than 60/min is not a sole reason to avoid taking digoxin; rather, it is important to monitor the heart rate and consult with the healthcare provider if there are concerns.

3. A nurse is reviewing the medical record of a client who is 24 hours postoperative following abdominal surgery. Which of the following findings should the nurse report to the provider?

• A. Heart rate 90/min
• B. Serosanguineous drainage in the surgical drain
• C. Temperature 38.6°C (101.5°F)
• D. Urinary output 60 mL/hr

Correct answer: C

Rationale: The correct answer is C. A temperature of 38.6°C (101.5°F) is above the normal range and indicates a fever, which is a concerning finding postoperatively. Fever can be a sign of infection, so the nurse should report this finding to the provider for further evaluation and intervention. Choices A, B, and D are within expected parameters for a client who is 24 hours postoperative following abdominal surgery and do not require immediate reporting. A heart rate of 90/min, serosanguineous drainage in the surgical drain, and a urinary output of 60 mL/hr are all common postoperative findings that do not raise immediate concerns.

4. What is the priority intervention for a patient with suspected pulmonary embolism?

• A. Administer oxygen
• B. Administer anticoagulants
• C. Administer bronchodilators
• D. Reposition the patient

Correct answer: A

Rationale: Administering oxygen is the priority intervention for a patient with suspected pulmonary embolism. Maintaining adequate oxygenation is crucial in these patients to prevent hypoxemia and support oxygen delivery to tissues. Administering anticoagulants may be necessary but is not the initial priority. Administering bronchodilators is not indicated for pulmonary embolism. Repositioning the patient does not address the immediate need for oxygenation.

5. A nurse is providing discharge teaching to a client who is postoperative following a total hip arthroplasty. Which of the following instructions should the nurse include?

• A. Cross your legs when sitting to increase circulation.
• B. Bend at the waist when picking up objects.
• C. Avoid crossing your legs when sitting.
• D. Avoid using a raised toilet seat.

Correct answer: C

Rationale: The correct answer is C: 'Avoid crossing your legs when sitting.' After a total hip arthroplasty, it is important for clients to avoid crossing their legs to prevent complications such as dislocation. Crossing the legs can put strain on the new hip joint, increasing the risk of dislocation. Choice A is incorrect as crossing legs can be harmful. Choice B is incorrect as bending at the waist can strain the hip joint, leading to complications. Choice D is incorrect as using a raised toilet seat is recommended after hip surgery to prevent excessive bending at the hip joint.

Similar Questions