Nursing Elites

1. A client who had a hip replacement is being prepared for discharge. What should the nurse include in the discharge teaching to prevent hip dislocation?

• A. Avoid crossing your legs at the knees or ankles.
• B. Do not sleep on the side of the hip that was operated on.
• C. Sit in high chairs and keep your knees higher than your hips.
• D. Do not bend forward at the waist to pick up objects.

Correct answer: A

Rationale: The correct answer is A: 'Avoid crossing your legs at the knees or ankles.' Crossing legs at the knees or ankles can cause excessive stress on the new hip joint, leading to a risk of dislocation. Choice B is incorrect because sleeping on the side of the operated hip can also increase the risk of dislocation. Choice C is incorrect as sitting in low chairs with knees higher than hips is a recommended position to prevent hip dislocation. Choice D is incorrect because bending forward at the waist to pick up objects can strain the hip joint and increase the risk of dislocation.

2. The nurse is caring for an elderly female client who tells the nurse, 'When I sneeze, I wet my pants.' After discussing the client's complaint with the charge nurse, the nurse plans to reinforce teaching about the importance of Kegel exercises. What muscles are involved in these exercises?

• A. Pectoral muscles
• B. Buttock muscles
• C. Abdominal muscles
• D. Pelvic floor muscles

Correct answer: D

Rationale: Kegel exercises involve the pelvic floor muscles. These muscles help strengthen the muscles controlling urination, potentially reducing symptoms of urinary incontinence. Pectoral muscles (Choice A), responsible for movement of the shoulders and arms, are not involved in Kegel exercises. Buttock muscles (Choice B) are primarily responsible for hip movement and stability, not related to Kegel exercises. Abdominal muscles (Choice C) support the core and trunk but are not the focus of Kegel exercises.

3. In what order should the PN implement these steps to provide wound care? (Place in correct order.)

• A. Don procedure gloves
• B. Remove the dressing
• C. Apply prescribed medications to the wound
• D. All of the Above

Correct answer: D

Rationale: The correct answer is 'D - All of the Above.' The PN should first don procedure gloves to maintain aseptic technique, then remove the dressing to assess the wound, and finally apply prescribed medications to the wound. This sequence ensures that non-sterile tasks like donning gloves are done before sterile tasks like applying medications, reducing the risk of wound contamination. Choices A, B, and C are all essential steps in providing effective wound care.

4. At the first dressing change, the PN tells the client that her mastectomy incision is healing well, but the client refuses to look at the incision and refuses to talk about it. Which response by the PN to the client's silence is best?

• A. You will feel better when you see that the incision is not as bad as you may think.
• B. It's OK if you don't want to look or talk about the mastectomy. I will be available when you're ready.
• C. Part of recovery is accepting your new body image, and you will need to look at your incision.
• D. Would you like me to call another nurse to be here while I show you the wound?

Correct answer: B

Rationale: Acknowledging the client's feelings and providing emotional support without pressuring them to look at the incision is important. Choice B is the best response as it respects the client's emotional readiness to confront their body image changes. The client's autonomy and emotional needs are prioritized in this response. Choice A may invalidate the client's feelings by assuming the incision is not as bad as they think, potentially dismissing their emotions. Choice C is insensitive as it imposes a particular view of recovery on the client, disregarding their current emotional state. Choice D may escalate the situation by suggesting the need for another nurse, which could make the client feel uncomfortable and pressured.

5. While caring for a client with an AV fistula in the left forearm, the nurse observed a palpable buzzing sensation over the fistula. What action should the nurse take?

• A. Loosen the dressing of the fistula
• B. Report the presence of a bounding pulse
• C. Document that the fistula is intact
• D. Apply gentle pressure over the site

Correct answer: C

Rationale: The correct answer is C: Document that the fistula is intact. The palpable buzzing sensation (known as a thrill) over the AV fistula indicates proper functioning. It is essential for the nurse to document this finding to ensure ongoing monitoring of the fistula's status. Choices A, B, and D are incorrect. Choice A is incorrect because there is no indication to loosen the dressing. Choice B is incorrect as a bounding pulse is not associated with the palpable buzzing sensation of a thrill. Choice D is incorrect as applying pressure over the site is not necessary for this situation.

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