Nursing Elites

1. How far should the enema tube be inserted for a client to have a flatus-reducing enema?

• A. 4 inches.
• B. 6 inches.
• C. 2 inches.
• D. 8 inches.

Correct answer: A

Rationale: The correct answer is to insert the enema tube 4 inches. Enema tubing must be passed beyond the internal sphincter, which is typically around 4 inches in an adult. Inserting the tube only 2 inches is not far enough to reach this point. On the other hand, inserting the tube 6 or 8 inches is too far and might cause trauma to the bowel, which is unnecessary for a flatus-reducing enema. Therefore, the correct insertion depth of the enema tube is crucial to ensure effectiveness and safety in providing the intended treatment.

2. A nurse working the 7 a.m. to 3 p.m. shift is reviewing the records of the assigned clients. Which client should the nurse assess first?

• A. A client scheduled for hemodialysis at 10 a.m.
• B. A client scheduled for contrast computed tomography (CT) at noon.
• C. A client scheduled for a nuclear scanning procedure at 10 a.m.
• D. A client scheduled for hydrotherapy for the treatment of a burn injury at 10:30 a.m.

Correct answer: A

Rationale: The correct answer is the client scheduled for hemodialysis at 10 a.m. This client needs immediate assessment before the procedure, which may take up to 5 hours. The nurse should ensure the client is physically and emotionally prepared, check for fluid overload by assessing weight and lung sounds, review vital signs, and laboratory test results. The other clients described in the options have needs that are not as urgent. The client scheduled for a nuclear scanning procedure at 10 a.m. may require information reinforcement and increased fluid intake before the procedure. The client scheduled for hydrotherapy for the treatment of a burn injury at 10:30 a.m. may need pain medication administered 30 minutes prior to the therapy. The client scheduled for a contrast CT at noon may need procedure information reinforcement and a special contrast preparation just before the procedure.

3. When a drug is listed as Category X and prescribed to women of child-bearing age/capacity, the nurse and the interdisciplinary team should counsel the client that:

• A. Pregnancy tests are not reliable while taking the drug.
• B. She must use a reliable form of birth control.
• C. She should not take the Category X drug on days she has intercourse.
• D. She must follow up with an endocrinologist.

Correct answer: B

Rationale: When a drug is categorized as Category X, it signifies that there are significant risks of fetal abnormalities if taken during pregnancy. For this reason, women of child-bearing age/capacity should use reliable forms of birth control to prevent pregnancy while on the medication. This ensures that the client avoids the potential harm to the fetus. Option A is incorrect because pregnancy tests are not unreliable due to the drug, but rather the risk is related to potential harm to the fetus. Option C is incorrect as avoiding the drug only on days of intercourse does not provide sufficient protection against pregnancy. Option D is incorrect as the need for an endocrinologist is not directly related to the use of Category X drugs.

4. An 80-year-old aphasic CVA client had abdominal surgery 2 days ago. Which of the following puts this client at the highest risk for inadequate pain management?

• A. Inability to turn, cough, and breathe deeply
• B. Inability to communicate pain
• C. Inability to ambulate freely
• D. Inability to use a bedside commode

Correct answer: B

Rationale: The correct answer is B: Inability to communicate pain. In this scenario, the client's aphasia prevents them from verbally expressing their pain, which can lead to inadequate pain management if the healthcare team is not vigilant. The nurse must use alternative methods to assess and address the client's pain. Choices A, C, and D, although important considerations in postoperative care, do not directly relate to the client's ability to communicate pain, which is crucial for effective pain management in this case.

5. A risk management program within a hospital is responsible for all of the following except:

• A. identifying risks.
• B. controlling financial loss due to malpractice claims.
• C. ensuring that staff follow their job descriptions.
• D. analyzing risks and trends to guide further interventions or programs.

Correct answer: C

Rationale: A risk management program within a hospital is responsible for identifying risks, controlling financial loss due to malpractice claims, and analyzing risks and trends to guide further interventions or programs. It is not responsible for ensuring that staff follow their job descriptions. Monitoring staff adherence to their job descriptions falls under the purview of departmental managers or supervisors. The primary focus of a risk management program is to assess, mitigate, and manage risks related to patient safety, quality of care, and financial implications, rather than overseeing staff job descriptions.

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