Nursing Elites

1. A middle-aged adult in a clinical setting mentions being at average risk for colon cancer and asks about routine screening. What should the nurse recommend?

• A. Performing a blood sample for a screening test.
• B. Scheduling a colonoscopy starting at age 60.
• C. Undergoing a fecal occult blood test annually.
• D. Having a sigmoidoscopy every 10 years.

Correct answer: C

Rationale: The correct answer is C. Colorectal cancer screening for individuals at average risk typically begins at age 50. One of the recommended options for routine screening is a fecal occult blood test done annually. Choice A is incorrect as blood samples are not used for routine colorectal cancer screening. Choice B is incorrect because colonoscopies usually start at age 50, not 60. Choice D is incorrect as sigmoidoscopies are recommended every 5 years, not every 10 years, for individuals at average risk for colon cancer.

2. A client with a left leg cast is being taught how to use crutches. Which of the following statements should indicate to the nurse that the client understands the teaching?

• A. When descending stairs, I will first shift my weight to my right (unaffected) leg.
• B. I will use crutches to support my weight on my left leg.
• C. When ascending stairs, I will lead with my left leg.
• D. I will keep my crutches under my arms for support.

Correct answer: A

Rationale: The correct answer is A. Shifting weight to the unaffected leg when descending stairs is crucial for maintaining balance and safety. This technique helps prevent falls and distributes weight appropriately. Choices B, C, and D are incorrect because using crutches to support the weight on the injured leg, leading with the injured leg when ascending stairs, and keeping crutches under the arms are all potentially unsafe practices that could lead to further injury or accidents.

3. A nurse on a medical-surgical unit is caring for a client. Which of the following actions should the nurse take first when using the nursing process?

• A. Obtain client information
• B. Develop a plan of care
• C. Implement nursing interventions
• D. Evaluate the client's response to treatment

Correct answer: A

Rationale: The correct answer is A: Obtain client information. The first step in the nursing process is assessment, which involves gathering data about the client's condition, needs, and preferences. This information forms the foundation for developing a comprehensive plan of care. Developing a plan of care (Choice B) comes after assessment to address the identified needs. Implementing nursing interventions (Choice C) follows the development of the plan of care. Evaluating the client's response to treatment (Choice D) occurs after implementing the interventions to determine the effectiveness of the care provided. Therefore, the initial and priority step is to obtain client information through assessment.

4. Which client statement from the assessment data is likely to explain their noncompliance with propranolol hydrochloride (Inderal)?

• A. I have problems with diarrhea.
• B. I have difficulty falling asleep.
• C. I have diminished sexual function.
• D. I often feel jittery.

Correct answer: C

Rationale: The correct answer is C. Propranolol hydrochloride (Inderal) is known to cause side effects such as diminished sexual function, which can lead to noncompliance with the medication due to its impact on quality of life. Choices A, B, and D are less likely to be associated with propranolol hydrochloride. While diarrhea, difficulty falling asleep, and feeling jittery are possible side effects of propranolol, they are not as commonly reported as diminished sexual function. Therefore, choice C is the most likely reason for the client's noncompliance.

5. When planning home care for a 72-year-old client with osteomyelitis requiring a 6-week course of intravenous antibiotics, what is the most important action by the nurse?

• A. Investigating the client's insurance coverage for home IV antibiotic therapy
• B. Determining if there are adequate hand washing facilities in the home
• C. Assessing the client's ability to participate in self-care and/or the reliability of a caregiver
• D. Selecting the appropriate venous access device

Correct answer: C

Rationale: Assessing the client's ability to participate in self-care or evaluating the reliability of a caregiver is crucial in ensuring adherence to the treatment plan. This action helps determine if the client can manage the intravenous antibiotics at home independently or if assistance is needed. Investigating insurance coverage, ensuring hand washing facilities, and selecting the venous access device are important aspects of care but assessing the client's ability for self-care and caregiver reliability takes precedence to promote treatment success and safety.

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