Nursing Elites

1. A female Native American client who is receiving chemotherapy places a native artifact, an Indian medicine wheel, in her hospital room. The HCP removes the medicine wheel and tells the client, 'This type of thing does not belong in the hospital.' Which intervention should the PN implement?

• A. Teach the client about the importance of adhering to the chemotherapy regimen
• B. Act as the client's advocate when addressing the issue with the HCP
• C. Consult with a Native American healer about the appropriate use of a medicine wheel
• D. Inform the HCP about the client's feelings of culture shock

Correct answer: B

Rationale: Acting as the client's advocate is the most appropriate intervention in this situation. Removing a culturally significant artifact without considering the client's beliefs and emotional needs can be distressing. By advocating for the client, the PN can ensure that the client's cultural practices are respected, which is crucial for her emotional and spiritual well-being during treatment. Choice A is incorrect because while chemotherapy adherence is important, it is not the most immediate concern in this scenario. The client's cultural needs and well-being take precedence. Choice C is incorrect because consulting with a Native American healer might not be necessary at this point and could delay addressing the immediate issue of advocating for the client's rights. Choice D is incorrect because simply reporting the client's feelings of culture shock to the HCP does not actively address the situation or advocate for the client's rights and cultural needs.

2. During a blood transfusion, which sign or symptom should prompt the healthcare provider to immediately stop the transfusion?

• A. Slight increase in blood pressure
• B. Elevated temperature and chills
• C. Mild nausea
• D. Slight headache

Correct answer: B

Rationale: The correct answer is B: Elevated temperature and chills. These symptoms are indicative of a transfusion reaction, which can be severe and life-threatening. It is crucial to stop the transfusion immediately and notify the healthcare provider for further assessment and management. Elevated temperature and chills are classic signs of a transfusion reaction, specifically indicating a possible febrile non-hemolytic reaction. Choice A, a slight increase in blood pressure, is not typically a reason to stop a transfusion unless it is a significant sudden increase. Mild nausea (Choice C) and a slight headache (Choice D) are common side effects of blood transfusions and are not primary indicators of a transfusion reaction that require immediate cessation of the transfusion.

3. A client on bedrest refuses to wear the prescribed pneumatic compression devices after surgery. Which action should the PN implement in response to the client's refusal?

• A. Emphasize the importance of active foot flexion
• B. Check the surgical dressing
• C. Complete an incident report
• D. Explain the use of an incentive spirometer every 2 hours

Correct answer: A

Rationale: The correct action for the PN to implement when a client refuses pneumatic compression devices is to emphasize the importance of active foot flexion. Active foot flexion exercises can help prevent deep vein thrombosis (DVT) in clients who are not using the compression devices. Encouraging some form of circulation-promoting activity is crucial to reduce the risks associated with immobility. Checking the surgical dressing (Choice B) is important but not the immediate action to address the refusal of compression devices. Completing an incident report (Choice C) is not necessary in this situation as the client's refusal is not an incident. Explaining the use of an incentive spirometer (Choice D) is not directly related to addressing the refusal of compression devices for DVT prevention.

4. 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.

5. Which condition is commonly screened for in newborns using the Guthrie test?

• A. Phenylketonuria (PKU)
• B. Cystic fibrosis
• C. Down syndrome
• D. Sickle cell anemia

Correct answer: A

Rationale: The Guthrie test is specifically designed to screen newborns for phenylketonuria (PKU), a metabolic disorder that can lead to intellectual disability if left untreated. Phenylketonuria is caused by the deficiency of an enzyme required to metabolize the amino acid phenylalanine. Screening for PKU in newborns is crucial as early diagnosis and intervention can prevent the severe consequences associated with the condition. Choices B, C, and D are incorrect as the Guthrie test is not used to screen for cystic fibrosis, Down syndrome, or sickle cell anemia.

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