Nursing Elites

1. A nurse in a long-term care facility is admitting a client who is incontinent and smells strongly of urine. His partner, who has been caring for him at home, is embarrassed and apologizes for the smell. Which of the following responses should the nurse make?

• A. "It must be difficult to care for someone who is confined to bed."
• B. "It is important to keep the client clean to avoid infections."
• C. "I understand that this is challenging; let’s work together to ensure comfort."
• D. "The smell is quite strong; we need to address this immediately."

Correct answer: C

Rationale: The correct response is C: "I understand that this is challenging; let’s work together to ensure comfort." This response acknowledges the difficulty the partner is facing, shows empathy, and offers to collaborate in providing care. Choice A is incorrect because it does not directly address the partner's feelings of embarrassment or offer support. Choice B, while true, does not address the partner's emotional state and may come across as directive rather than supportive. Choice D is also incorrect as it focuses solely on the smell without addressing the partner's emotions or offering assistance in managing the situation with empathy.

2. A client is to receive cimetidine (Tagamet) 300 mg q6h IVP. The preparation arrives from the pharmacy diluted in 50 ml of 0.9% NaCl. The LPN plans to administer the IVPB dose over 20 minutes. For how many ml/hr should the infusion pump be set to deliver the secondary infusion?

• A. 150
• B. 50
• C. 100
• D. 75

Correct answer: A

Rationale: Setting the infusion pump to 150 ml/hr ensures the correct administration rate of the IVPB dose over 20 minutes. To calculate the infusion rate, consider that the total volume to be infused is 50 ml over 20 minutes. To convert this to ml/hr, the calculation is (50 ml / 20 minutes) x 60 minutes/hr = 150 ml/hr. Choices B, C, and D are incorrect as they do not reflect the correct calculation for the infusion rate needed to deliver the secondary infusion over the specified time.

3. What action should the nurse take to prevent the development of deep vein thrombosis (DVT) in a client who is postoperative day 2 following hip replacement surgery?

• A. Encourage the client to remain on bed rest as much as possible.
• B. Apply sequential compression devices (SCDs) to the client's legs.
• C. Massage the client's legs to improve circulation.
• D. Encourage the client to perform ankle and foot exercises.

Correct answer: B

Rationale: The correct action to prevent DVT in a postoperative client is to apply sequential compression devices (SCDs) to promote venous return. This helps prevent stasis of blood in the lower extremities, reducing the risk of clot formation. Encouraging bed rest (Choice A) may lead to decreased mobility and increase the risk of DVT. Massaging the client's legs (Choice C) is contraindicated in the presence of DVT as it can dislodge a clot. Encouraging ankle and foot exercises (Choice D) may be beneficial for circulation, but SCDs are more effective at preventing DVT in this scenario.

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 should discharge planning be initiated for a client experiencing an exacerbation of heart failure?

• A. During the admission process.
• B. After the client stabilizes.
• C. Only after the client requests it.
• D. At the time of discharge.

Correct answer: A

Rationale: Discharge planning should begin during the admission process for a client experiencing an exacerbation of heart failure. Initiating discharge planning early ensures timely and effective care transitions, which are crucial for managing the client's condition and preventing readmissions. Waiting until after the client stabilizes (choice B) could lead to delays in arranging necessary follow-up care and support services. Similarly, waiting for the client to request discharge planning (choice C) may result in missed opportunities for comprehensive care coordination. Planning at the time of discharge (choice D) is too late, as early intervention is key to promoting the client's well-being and recovery in the long term.

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