Nursing Elites

1. A patient is 1 day postoperative following a hip arthroplasty. Which of the following actions should the nurse take to prevent dislocation of the hip?

• A. Keep the patient in a side-lying position.
• B. Place a pillow between the patient's legs.
• C. Instruct the patient to avoid sitting for long periods.
• D. Elevate the head of the bed to 90 degrees.

Correct answer: B

Rationale: Placing a pillow between the patient's legs is the correct action to prevent dislocation of the hip following arthroplasty. This technique helps maintain proper alignment and stability of the hip joint. Keeping the patient in a side-lying position may not provide the necessary support to prevent hip dislocation. Instructing the patient to avoid sitting for long periods is important for preventing complications like deep vein thrombosis but does not directly prevent hip dislocation. Elevating the head of the bed to 90 degrees is not relevant to preventing hip dislocation in a postoperative hip arthroplasty patient.

2. A nurse is caring for a client who has a new diagnosis of deep-vein thrombosis (DVT). Which of the following actions should the nurse take?

• A. Massage the affected leg to relieve discomfort
• B. Place a heating pad on the affected leg
• C. Encourage the client to walk around frequently
• D. Monitor the client's oxygen saturation level

Correct answer: D

Rationale: The correct answer is to monitor the client's oxygen saturation level. Deep-vein thrombosis (DVT) increases the risk of pulmonary embolism, a life-threatening complication. Monitoring oxygen saturation helps in early detection of any signs of compromised respiratory function. Massaging the affected leg can dislodge a blood clot, leading to severe consequences. Applying heat through a heating pad can promote vasodilation and increase the risk of clot dislodgment. While mobility is essential in preventing DVT complications, encouraging excessive walking without proper assessment can potentially dislodge a clot and worsen the condition.

3. A client has a new prescription for furosemide. Which of the following statements should the nurse include in the teaching?

• A. This medication will increase your potassium levels.
• B. You should take this medication with food to prevent gastrointestinal upset.
• C. This medication will decrease your blood glucose levels.
• D. You should increase your intake of potassium-rich foods.

Correct answer: B

Rationale: The correct statement the nurse should include in the teaching for a client with a new prescription for furosemide is that the client should take the medication with food to prevent gastrointestinal upset. Furosemide is a loop diuretic that can cause gastrointestinal upset, so taking it with food can help reduce this side effect and improve medication tolerance. Choices A, C, and D are incorrect because furosemide does not increase potassium levels, decrease blood glucose levels, or require an increase in the intake of potassium-rich foods. Therefore, the most important teaching point for the client is to take furosemide with food.

4. A client has Clostridium difficile infection. Which of the following actions should the nurse take?

• A. Wash hands with an alcohol-based hand rub.
• B. Place the client on contact precautions.
• C. Wear a mask when entering the client's room.
• D. Double-bag all linens before removing them from the room.

Correct answer: B

Rationale: The correct action for the nurse to take when caring for a client with Clostridium difficile infection is to place the client on contact precautions. This helps prevent the spread of the infection to other clients. Washing hands with an alcohol-based hand rub is important for infection control but is not specific to preventing the spread of Clostridium difficile. Wearing a mask may be necessary for airborne precautions but is not the priority for Clostridium difficile infection. Double-bagging linens is not a standard practice for preventing the spread of Clostridium difficile.

5. What is the first intervention for a patient experiencing anaphylactic shock?

• A. Administer epinephrine
• B. Administer oxygen
• C. Administer corticosteroids
• D. Administer antihistamines

Correct answer: A

Rationale: The correct answer is to administer epinephrine. Epinephrine is the first-line treatment for anaphylactic shock as it helps reverse the severe allergic reaction by constricting blood vessels, increasing heart rate, and opening airways for improved breathing. Oxygen (Choice B) can be administered after epinephrine to support oxygenation. Corticosteroids (Choice C) may be used to prevent a biphasic reaction but are not the initial intervention. Antihistamines (Choice D) can help with itching and hives but do not address the life-threatening symptoms of anaphylaxis.

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