Nursing Elites

1. A client returning from the surgical suite following a vaginal hysterectomy is awake and asking for something to drink. Her post-op diet prescription reads: 'clear liquids, advance diet as tolerated.' Which of the following is appropriate for the nurse to tell the patient?

• A. ''I am going to listen to your abdomen.''
• B. ''You need to wait until the surgeon evaluates your condition.''
• C. ''You can have clear liquids, but let me check with the surgeon first.''
• D. ''It is best to start with small sips of clear liquids and observe how you feel.''

Correct answer: A

Rationale: The correct answer is A: ''I am going to listen to your abdomen.'' Listening to the abdomen helps assess bowel sounds and ensure that the client’s gastrointestinal system is ready for oral intake. Choice B is incorrect because the client does not necessarily need to wait for the surgeon to evaluate before starting with clear liquids. Choice C is incorrect because unless there are specific contraindications, clear liquids are usually allowed after surgery. Choice D is incorrect as it does not address the immediate assessment needed before initiating oral intake post-operatively.

2. The charge nurse on the unit observes that one of the staff nurses is not using proper hand washing techniques. Which is the most appropriate initial approach to correct the behavior?

• A. Remind the nurse that proper hand washing prevents infection
• B. Discuss what the nurse knows about proper hand hygiene
• C. Provide a review of the hand washing policy
• D. Refer the nurse to the infection control nurse

Correct answer: B

Rationale: The most appropriate initial approach to correct the behavior of improper hand washing by a staff nurse is to discuss what the nurse knows about proper hand hygiene. This approach helps in identifying any knowledge gaps the nurse may have and provides an opportunity to educate and correct the behavior. Option A is not the best choice as simply reminding the nurse about the importance of hand washing may not address the underlying issue of knowledge or technique. Option C, providing a review of the hand washing policy, may be necessary but is not the most immediate step to take. Option D, referring the nurse to the infection control nurse, is premature and may not be necessary if the issue can be resolved through education and communication first.

3. The nurse is caring for a client with a urinary tract infection (UTI). Which finding should the LPN/LVN report to the healthcare provider immediately?

• A. Cloudy urine
• B. Burning sensation during urination
• C. Foul-smelling urine
• D. Blood in the urine

Correct answer: D

Rationale: The presence of blood in the urine in a client with a urinary tract infection (UTI) may indicate a more severe infection, such as pyelonephritis, or complications like kidney stones or bladder cancer. Therefore, this finding should be reported immediately for further evaluation and management. Cloudy urine, burning sensation during urination, and foul-smelling urine are common symptoms of UTI and may not necessarily signify an urgent need for immediate reporting compared to the presence of blood in the urine.

4. The client has expressive aphasia and needs assistance to communicate. Which method should the LPN use to best support the client's ability to express basic needs?

• A. Use a picture board with common needs.
• B. Encourage the client to speak slowly.
• C. Write down what the client says.
• D. Use hand gestures to communicate.

Correct answer: A

Rationale: The correct answer is to use a picture board with common needs. Clients with expressive aphasia have difficulty speaking but can often understand and use visual aids effectively. Using a picture board helps the client communicate basic needs more easily. Encouraging the client to speak slowly (choice B) may not be effective as the issue lies with expressive language, not speed. Writing down what the client says (choice C) may not always be possible or helpful for immediate communication as it does not address the communication barrier directly. Using hand gestures (choice D) may not be as clear or universally understood as a picture board, which can cause confusion and misinterpretation.

5. A client with an NG tube is receiving intermittent feedings through an open system. Which of the following actions should the nurse take first?

• A. Rinse the feeding bag with water between feedings
• B. Tell the client to keep the head of the bed elevated at least 30°
• C. Make sure the enteral formula is at room temperature
• D. Wipe the top of the formula can with alcohol

Correct answer: B

Rationale: The correct answer is to tell the client to keep the head of the bed elevated at least 30°. Elevating the head of the bed prevents aspiration of the enteral formula, which is a priority in caring for a client with an NG tube. This action helps in reducing the risk of complications such as pneumonia. Choices A, C, and D are incorrect. While rinsing the feeding bag, ensuring the enteral formula temperature, and maintaining cleanliness are important aspects of enteral feeding care, the priority is to prevent aspiration by keeping the head of the bed elevated. These actions can be implemented after ensuring the client's safety by maintaining the correct bed position.

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