Nursing Elites

1. A client complains of difficulty swallowing when the nurse tries to administer capsule medication. Which of the following measures should the nurse take?

• A. Dissolve the capsule in a glass of water
• B. Break the capsule and give the contents with applesauce
• C. Check the availability of a liquid preparation
• D. Crush the capsule and place it under the tongue

Correct answer: C

Rationale: When a client has difficulty swallowing capsule medication, the nurse should check the availability of a liquid preparation. This is a safer approach and ensures that the medication's integrity is maintained, providing an alternative form that is easier for the client to take. Dissolving the capsule in water (choice A) may alter the medication's effectiveness, breaking the capsule and mixing the contents with applesauce (choice B) is not recommended as it may cause an unpleasant taste, and crushing the capsule and placing it under the tongue (choice D) can be unsafe and affect the medication's absorption.

2. What is the correct sequence for assessing the abdomen?

• A. Tympanic percussion, measurement of abdominal girth, and inspection
• B. Assessment for distention, tenderness, and discoloration around the umbilicus
• C. Percussion, palpation, and auscultation
• D. Auscultation, percussion, and palpation

Correct answer: D

Rationale: The correct sequence for assessing the abdomen is auscultation, percussion, and palpation. Auscultation allows the healthcare provider to listen for bowel sounds, followed by percussion to assess for areas of tenderness or abnormal distention, and finally palpation to feel for masses or organ enlargement. This sequence ensures a systematic and thorough assessment of the abdomen.

3. The correct method for determining the vastus lateralis site for I.M. injection is to:

• A. Locate the upper aspect of the upper outer quadrant of the buttock about 5 to 8 cm below the iliac crest
• B. Palpate the lower edge of the acromion process and the midpoint lateral aspect of the arm
• C. Palpate a 1” circular area anterior to the umbilicus
• D. Divide the area between the greater femoral trochanter and the lateral femoral condyle into thirds, and select the middle third on the anterior of the thigh

Correct answer: D

Rationale: The vastus lateralis site is located in the middle third of the thigh.

4. While teaching a newly hired nurse about varicella, a nurse in a pediatric clinic should include which of the following information?

• A. Children who have varicella are contagious until vesicles are crusted.
• B. Children who have varicella should receive the varicella (chickenpox) vaccine.
• C. Children who have varicella should be placed in airborne precautions.
• D. Children who have varicella are contagious 1-2 days before the rash appears.

Correct answer: A

Rationale: Children with varicella (chickenpox) are contagious until all vesicles are crusted over. The contagious period starts 1-2 days before the rash appears and continues until all lesions are dried and crusted. It is important to educate healthcare providers about the contagious period to prevent the spread of the virus to susceptible individuals.

5. Mrs. Mitchell has been given a copy of her diet. The nurse discusses the foods allowed on a 500-mg low sodium diet. These include:

• A. A ham and Swiss cheese sandwich on whole wheat bread
• B. Mashed potatoes and broiled chicken
• C. A tossed salad with oil and vinegar and olives
• D. Chicken bouillon

Correct answer: B

Rationale: The correct answer is B: Mashed potatoes and broiled chicken. Both mashed potatoes and broiled chicken are typically low in sodium content, making them suitable choices for a 500-mg low sodium diet. The other options, such as a ham and Swiss cheese sandwich on whole wheat bread, a tossed salad with oil and vinegar and olives, and chicken bouillon, may contain higher amounts of sodium and are not typically recommended for a low sodium diet.

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