Nursing Elites

1. A client has been diagnosed with terminal cancer. Which of the following interventions is a priority?

• A. Teach the client to use progressive relaxation techniques.
• B. Help the client find a local support group.
• C. Discuss the client's prior coping mechanisms.
• D. Develop a list of goals with the client.

Correct answer: D

Rationale: When a client receives a terminal cancer diagnosis, it is crucial to prioritize developing a list of goals with the client. This process helps the client focus on what is important to them, set achievable objectives, and maintain a sense of purpose and control. Teaching relaxation techniques (choice A) may be beneficial for symptom management but is not the priority when confronting a terminal illness. While finding a local support group (choice B) can be valuable for emotional support, it does not directly address setting goals. Discussing prior coping mechanisms (choice C) can provide insights into the client's coping strategies but may not be as essential as establishing future goals in the face of a terminal illness.

2. How should a healthcare professional care for a client approaching death with shortness of breath and noisy respirations?

• A. Turn the client every 2 hours
• B. Provide supplemental oxygen
• C. Use a fan to reduce the feeling of breathlessness
• D. Administer diuretics as prescribed

Correct answer: C

Rationale: In a palliative care setting, when caring for a client approaching death with symptoms of shortness of breath and noisy respirations, using a fan can help alleviate the sensation of breathlessness. This intervention can provide comfort by improving air circulation and reducing the perception of breathlessness. Turning the client every 2 hours may not directly address the respiratory distress caused by noisy respirations. Providing supplemental oxygen may not be indicated or effective in all cases, especially in end-of-life care where the focus is on comfort rather than aggressive interventions. Administering diuretics as prescribed would not be appropriate for addressing noisy respirations and shortness of breath in a dying client, as this may not be related to fluid overload or congestion. Therefore, the most appropriate action to help the client feel more comfortable in this situation is to use a fan to reduce the feeling of breathlessness.

3. When admitting a client with an abdominal wound, which precaution should be taken?

• A. Contact precautions
• B. Droplet precautions
• C. Airborne precautions
• D. Standard precautions

Correct answer: A

Rationale: When admitting a client with an abdominal wound, contact precautions should be implemented. Contact precautions are used to prevent the spread of infections that are spread by direct or indirect contact. In the case of abdominal wounds, bacteria and pathogens can easily be transmitted through contact with the wound or wound drainage. Droplet precautions are used for infections transmitted through respiratory droplets, such as influenza. Airborne precautions are used for infections spread through the air, like tuberculosis. Standard precautions are used for all clients to prevent the spread of infections and should be followed in addition to specific precautions based on the type of infection.

4. A client with a history of diabetes mellitus is experiencing polyuria, polydipsia, and polyphagia. What is the most important action for the nurse to take?

• A. Monitor the client's blood glucose level.
• B. Encourage the client to increase fluid intake.
• C. Administer insulin as prescribed.
• D. Assess the client's urine output.

Correct answer: A

Rationale: The most critical action for the nurse to take when a client with diabetes mellitus presents with symptoms of hyperglycemia such as polyuria, polydipsia, and polyphagia is to monitor the client's blood glucose level. This action helps in assessing the client's current glycemic status and guides further interventions. Encouraging increased fluid intake (Choice B) may be beneficial in managing dehydration caused by polyuria, but it does not address the underlying cause of hyperglycemia. Administering insulin as prescribed (Choice C) may be necessary based on the blood glucose monitoring results, but monitoring should precede any medication administration. Assessing the client's urine output (Choice D) is important but does not directly address the primary concern of evaluating and managing hyperglycemia in a client with diabetes.

5. A healthcare professional is admitting a client who has tuberculosis. Which of the following types of transmission precautions should the healthcare professional plan to initiate?

• A. Contact
• B. Droplet
• C. Airborne
• D. Protective environment

Correct answer: C

Rationale: Tuberculosis is transmitted through airborne particles, so airborne precautions are necessary to prevent the spread of the disease. Airborne precautions (Choice C) involve measures such as negative pressure rooms and N95 respirators to prevent the transmission of infectious agents that remain infectious over long distances when suspended in the air. Contact precautions (Choice A) are used for diseases that spread through direct contact with the patient or their environment. Droplet precautions (Choice B) are for diseases transmitted through respiratory droplets, typically over short distances. Protective environment (Choice D) is used for clients who are immunocompromised to protect them from environmental pathogens, not for diseases like tuberculosis that spread through the air.

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