Nursing Elites

1. A client has urinary incontinence, and the nurse is caring for them. Which of the following actions should the nurse implement to prevent the development of skin breakdown?

• A. Request a prescription for the insertion of an indwelling urinary catheter
• B. Check the client's skin every 8 hours for signs of breakdown
• C. Apply a moisture barrier ointment to the client's skin
• D. Clean the client's skin and perineum with hot water after each episode of incontinence

Correct answer: C

Rationale: The correct action to prevent skin breakdown in a client with urinary incontinence is to apply a moisture barrier ointment to the skin. This ointment helps protect the skin from the harmful effects of moisture exposure, reducing the risk of breakdown. Requesting an indwelling urinary catheter (Choice A) should not be the first-line intervention for skin breakdown prevention. Checking the client's skin for signs of breakdown (Choice B) is important but not as effective as applying a moisture barrier. Cleaning the skin with hot water (Choice D) can actually be detrimental as hot water can strip the skin of its natural oils and worsen skin integrity.

2. The nurse notes that a healthcare provider has prescribed a higher than normal dose of medication. What action should the nurse take?

• A. Administer the prescribed dose
• B. Ask another nurse to verify the dose
• C. Administer half of the dose
• D. Contact the healthcare provider to clarify the prescription

Correct answer: D

Rationale: When a healthcare provider prescribes a dose that is higher than normal, it is crucial for the nurse to contact the provider to clarify the prescription. Administering the prescribed dose without clarification can lead to potential harm to the patient due to the elevated dosage. Asking another nurse to verify the dose may not provide the necessary clarification from the prescriber. Administering only half of the prescribed dose without consulting the healthcare provider is not the appropriate action, as the full rationale behind the higher dose needs to be understood before any administration.

3. After surgery, a patient is experiencing pain. What is the nurse's priority action?

• A. Administer pain medication as prescribed.
• B. Assess the patient's pain using a pain scale.
• C. Offer the patient non-pharmacological pain relief methods.
• D. Reassess the patient's pain level after 30 minutes.

Correct answer: B

Rationale: The correct answer is to assess the patient's pain using a pain scale. This is the priority action because it allows the nurse to obtain an objective measure of the patient's pain intensity. By accurately assessing the pain level, the nurse can determine the appropriate intervention, which may include administering pain medication as prescribed (choice A) or offering non-pharmacological pain relief methods (choice C). Reassessing the patient's pain level after 30 minutes (choice D) is important but comes after the initial assessment to evaluate the effectiveness of the interventions implemented.

4. A nurse is providing discharge teaching to a client following a cataract extraction. Which of the following instructions should the nurse include?

• A. Bend at the waist when picking up objects.
• B. Avoid lying on the operative side.
• C. Avoid lifting more than 10 lb.
• D. Apply ice to the affected eye.

Correct answer: C

Rationale: The correct answer is C: 'Avoid lifting more than 10 lb.' After a cataract extraction, the nurse should instruct the client to avoid lifting heavy objects to prevent increased intraocular pressure, which could lead to complications. Choices A, B, and D are incorrect. A - 'Bend at the waist when picking up objects' can increase intraocular pressure; B - 'Avoid lying on the operative side' is not a specific concern related to cataract extraction; D - 'Apply ice to the affected eye' is not a standard post-cataract extraction instruction.

5. A healthcare professional suspects a colleague of diverting narcotics. What is the first step the healthcare professional should take?

• A. Confront the colleague directly
• B. Report the suspicion to the supervisor
• C. Ignore the issue and continue working
• D. Notify the pharmacy about the colleague's behavior

Correct answer: B

Rationale: The correct first step for a healthcare professional who suspects a colleague of diverting narcotics is to report the suspicion to the supervisor. This action is essential to protect patient safety, uphold ethical standards, and comply with legal obligations. Confronting the colleague directly may not only escalate the situation but also jeopardize the investigation process. Ignoring the issue and continuing to work could potentially harm patients and violate professional responsibilities. Notifying the pharmacy, while important, should come after informing the appropriate supervisor or authority within the healthcare facility.

Similar Questions