Nursing Elites

1. While caring for a client with tuberculosis, which of the following actions should the nurse take?

• A. Use antimicrobial sanitizer for hand hygiene.
• B. Wear a surgical mask when providing client care.
• C. Limit each visitor to 2-hour increments.
• D. Wear gloves when assisting the client with oral care.

Correct answer: A

Rationale: The correct action for the nurse to take when caring for a client with tuberculosis is to use antimicrobial sanitizer for hand hygiene. Tuberculosis is primarily spread through the air, so wearing a surgical mask when providing care (choice B) would be more appropriate for diseases transmitted via droplets. Limiting visitors (choice C) and wearing gloves for oral care (choice D) are important infection control measures but are not specifically tailored to tuberculosis transmission.

2. After receiving change-of-shift report, which patient should the nurse assess first?

• A. 19-year-old with type 1 diabetes who has a hemoglobin A1C of 12%
• B. 23-year-old with type 1 diabetes who has a blood glucose of 40 mg/dL
• C. 40-year-old who is pregnant and has an oral glucose tolerance test result of 202 mg/dL
• D. 50-year-old who uses exenatide (Byetta) and is complaining of acute abdominal pain

Correct answer: B

Rationale: The correct answer is B because the patient with a blood glucose level of 40 mg/dL (hypoglycemia) needs immediate attention. Hypoglycemia is an emergency situation that requires prompt intervention to prevent adverse effects such as seizures or loss of consciousness. Assessing and managing this patient first is crucial to prevent further deterioration. Choices A, C, and D do not present immediate life-threatening situations requiring urgent intervention like severe hypoglycemia does. While a high hemoglobin A1C level (choice A), an abnormal oral glucose tolerance test result (choice C), and acute abdominal pain (choice D) are important issues, they do not pose an immediate threat to the patient's life compared to severe hypoglycemia.

3. A nurse is initiating a protective environment for a client who has had an allogeneic stem cell transplant. Which of the following precautions should the nurse plan for this client?

• A. Wear an N95 respirator when giving direct care to the client.
• B. Place the client in a private room with negative-pressure airflow.
• C. Ensure the client's room has at least six air exchanges per hour.
• D. Ensure the client wears a mask when outside their room if there is construction in the area.

Correct answer: A

Rationale: In a protective environment for a client with an allogeneic stem cell transplant, the nurse needs to wear an N95 respirator when providing direct care to the client. This precaution is essential to protect the client, whose immune system is compromised after the transplant, from exposure to potential pathogens. Placing the client in a private room with negative-pressure airflow (choice B) is more appropriate for clients with airborne infections. Ensuring the client's room has sufficient air exchanges (choice C) is important for maintaining air quality but is not the primary precaution for protecting an immunocompromised client. Making the client wear a mask when outside the room due to construction (choice D) focuses on external factors and does not directly address the risk of infection during direct care.

4. A client who is postoperative is verbalizing pain as a 2 on a pain scale of 0 to 10. Which of the following statements should the nurse identify as an indication that the client understands the preoperative teaching they received about pain management?

• A. ''I think I should take my pain medication more often, since it is not controlling my pain.''
• B. ''Breathing faster will help me keep my mind off of the pain.''
• C. ''It might help me to listen to music while I'm lying in bed.''
• D. ''I don't want to walk today because I have some pain.''

Correct answer: D

Rationale: The correct answer is D because the client is demonstrating an understanding of the preoperative teaching by acknowledging the pain and relating it to the need to rest. Walking may exacerbate the pain, and the client's decision not to walk shows an awareness of their body's signals. Choices A, B, and C are incorrect as they do not reflect a good understanding of pain management. Choice A suggests self-medicating without consulting healthcare providers, choice B focuses on distraction rather than addressing the pain, and choice C offers a coping mechanism but does not address the pain directly.

5. The staff on a medical-surgical unit is in conflict with the occupational therapy department. What type of communication will be used to discuss the problems?

• A. Downward communication
• B. Lateral communication
• C. Distorted communication
• D. Upward communication

Correct answer: B

Rationale: The correct answer is B: Lateral communication. Lateral communication occurs between individuals or departments of the same hierarchical level, making it suitable for addressing conflicts between the staff on a medical-surgical unit and the occupational therapy department. Upward communication involves communication from staff to management or from lower management to middle or upper management. Downward communication is typically directive communication from an authority figure or manager to staff. Distorted communication is not a recognized type of communication and does not apply to this scenario.

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