Nursing Elites

1. A client with a history of chronic pain requests a nonopioid analgesic. The client is alert but has difficulty describing the exact nature and location of the pain to the nurse. What action should the nurse implement next?

• A. Administer the analgesic as requested.
• B. Request a pain assessment from another nurse.
• C. Ask the client to describe the pain more precisely.
• D. Delay administration until the pain is better described.

Correct answer: D

Rationale: The correct action for the nurse to implement next is to delay administration until the pain is better described. It is essential to have a clear understanding of the nature and location of the pain before administering any analgesic to ensure appropriate and effective pain management. Requesting a pain assessment from another nurse or asking the client to describe the pain more precisely would also be appropriate actions to obtain more information before administering the analgesic. Administering the analgesic as requested without a clear description of the pain may not address the client's needs effectively and could potentially lead to ineffective pain management.

2. The nurse instructs the mother of a child with a ventricular septal defect that she can expect the child to become cyanotic when the child does what?

• A. Experiences an elevation in temperature.
• B. Sleeps on the left side.
• C. Cries vigorously.
• D. Eats.

Correct answer: C

Rationale: The correct answer is C: Cries vigorously. When the child cries vigorously, it increases the pressure in the right ventricle, allowing unoxygenated blood to enter the circulating volume, leading to cyanosis. This occurs due to the shunting of blood from the right side of the heart to the left side through the ventricular septal defect. Choices A, B, and D are incorrect because they do not directly impact the pressure in the right ventricle, which is crucial in causing cyanosis in this scenario.

3. The nurse is obtaining a client's fingerstick glucose level. After gently milking the client's finger, the nurse observes that the distal tip of the finger appears reddened and engorged. What action should the nurse take?

• A. Collect the blood sample
• B. Assess radial pulse volume
• C. Apply pressure to the site
• D. Select another finger

Correct answer: A

Rationale: When the nurse observes that the distal tip of the client's finger is reddened and engorged after milking, it indicates adequate blood flow. At this point, the appropriate action is to collect the blood sample for glucose level testing. Assessing radial pulse volume (Choice B) is unrelated to the situation and not necessary. Applying pressure to the site (Choice C) may disrupt the blood sample collection process. Selecting another finger (Choice D) is not warranted as the engorgement indicates sufficient blood flow for sampling.

4. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy at 2 liters per minute via a nasal cannula. Which assessment finding indicates a potential complication of oxygen therapy?

• A. Increased respiratory rate
• B. Decreased level of consciousness
• C. Improved oxygen saturation
• D. Complaints of dry mouth

Correct answer: B

Rationale: In clients with COPD, oxygen therapy can lead to a decrease in the respiratory drive caused by the removal of the hypoxic drive. This can result in carbon dioxide retention, leading to a decreased level of consciousness. Options A, C, and D are incorrect because an increased respiratory rate is typically a sign of hypoxia, improved oxygen saturation is a positive response to oxygen therapy, and complaints of dry mouth are not directly related to oxygen therapy complications in this scenario.

5. The mother of a child who has been diagnosed with varicella asks the nurse when the child can return to school. When is the child no longer contagious?

• A. When the fever dissipates
• B. After the incubation period
• C. When the lesions have healed
• D. When the lesions are crusted over

Correct answer: D

Rationale: The correct answer is D: 'When the lesions are crusted over.' Varicella is no longer contagious once the lesions are dry and crusted. This stage indicates that the active viral shedding has significantly decreased, reducing the risk of transmission. Choice A, 'When the fever dissipates,' is incorrect because the presence of fever does not necessarily correlate with the contagiousness of varicella. Choice B, 'After the incubation period,' is incorrect as the incubation period occurs before the onset of symptoms and is not relevant to determining contagiousness. Choice C, 'When the lesions have healed,' is incorrect as healed lesions can still be contagious if they are not crusted over.

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