Nursing Elites

1. A healthcare professional is assessing postoperative circulation of the lower extremities for a client who had knee surgery. The healthcare professional should test which of the following?

• A. Range of motion
• B. Skin color
• C. Edema
• D. Skin temperature

Correct answer: B

Rationale: Corrected Rationale: Assessing skin color is crucial to evaluate perfusion and circulation postoperatively. Skin color changes can indicate compromised circulation, such as pallor or cyanosis. Edema may suggest fluid retention but is not a direct indicator of circulation status. Range of motion is more related to joint function and mobility, not specifically circulation.

2. The patient is reporting an inability to clear nasal passages. Which action will the nurse take?

• A. Use gentle suction to prevent tissue damage.
• B. Instruct the patient to blow their nose forcefully to clear the passage.
• C. Place a dry washcloth under the nose to absorb secretions.
• D. Insert a cotton-tipped applicator into the back of the nose.

Correct answer: A

Rationale: When a patient reports an inability to clear nasal passages, the appropriate action for the nurse to take is to use gentle suction to prevent tissue damage. Suctioning helps remove excess mucus or secretions without causing harm to the nasal tissues. Instructing the patient to blow their nose forcefully (Choice B) may exacerbate the issue and cause discomfort or injury. Placing a dry washcloth under the nose (Choice C) is not an effective intervention for clearing nasal passages. Inserting a cotton-tipped applicator into the back of the nose (Choice D) is not recommended as it can be invasive and may cause injury or discomfort to the patient.

3. A client with a new colostomy is being taught how to irrigate the ostomy. The healthcare provider realizes that the client needs further teaching when the client:

• A. Positions the irrigating solution bag 30 inches below the stoma
• B. Uses an open system for irrigation
• C. Irrigates the colostomy twice a day
• D. Cleans the stoma with harsh chemicals

Correct answer: A

Rationale: The correct answer is A. Positioning the irrigating solution bag 30 inches below the stoma would cause discomfort and ineffective irrigation as the bag should be positioned at a lower level. Option B is incorrect because a closed system for irrigation is the preferred method for colostomy irrigation. Option C is incorrect as colostomy irrigation is typically done once a day unless otherwise instructed by a healthcare provider. Option D is incorrect as the stoma should be cleaned with mild soap and water to prevent skin irritation and damage.

4. Which action is most important for maintaining sterility when donning sterile gloves?

• A. Maintain thumbs at a ninety-degree angle.
• B. Hold hands with fingers pointing downward while gloving.
• C. Keep gloved hands above the elbows.
• D. Put the glove on the dominant hand first.

Correct answer: C

Rationale: The most crucial action for maintaining sterility when donning sterile gloves is to keep gloved hands above the elbows. This practice is essential to prevent potential contamination and maintain a sterile field. Choices A, maintaining thumbs at a ninety-degree angle, and B, holding hands with fingers pointing downward while gloving, are not as critical as keeping hands above the elbows for maintaining sterility. Choice D, putting the glove on the dominant hand first, is not as important as ensuring that gloved hands are kept above the elbows to maintain sterility.

5. A healthcare provider is providing discharge teaching to a client who does not speak the same language. Which of the following actions should the healthcare provider take?

• A. Use proper medical terms when providing instructions to the client.
• B. Offer written instructions in the client’s language.
• C. Direct verbal discharge instructions to the interpreter.
• D. Request that an assistive personnel interpret instructions for the client.

Correct answer: B

Rationale: The correct action for the healthcare provider when providing discharge teaching to a client who does not speak the same language is to offer written instructions in the client’s language. This approach helps ensure better comprehension and adherence to the instructions as the client can refer back to the written material for clarification. Choice A is incorrect because using proper medical terms may not be effective if the client does not understand the language. Choice C is incorrect since verbal instructions should be directed to the client for better understanding. Choice D is incorrect as assistive personnel may not be qualified or trained to provide accurate interpretation, risking miscommunication and potential errors in the instructions.

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