Nursing Elites

1. A client is 48 hours postoperative following a small bowel resection. The client reports gas pains in the periumbilical area. The nurse should plan care based on which of the following factors contributing to this postoperative complication?

• A. Impaired peristalsis of the intestines
• B. Infection at the surgical site
• C. Fluid overload
• D. Inadequate pain management

Correct answer: A

Rationale: Gas pains in the periumbilical area postoperatively are often caused by impaired peristalsis and bowel function. Following abdominal surgery, it is common for peristalsis to be reduced due to surgical manipulation and anesthesia effects. This reduction in peristalsis can lead to the accumulation of gas in the intestines, resulting in gas pains. Infection at the surgical site (Choice B) would present with localized signs of infection such as redness, swelling, warmth, and drainage, rather than diffuse gas pains. Fluid overload (Choice C) would manifest with symptoms such as edema, increased blood pressure, and respiratory distress, not gas pains. Inadequate pain management (Choice D) may lead to increased discomfort, but it is not the primary cause of gas pains in the periumbilical area following a small bowel resection.

2. A nurse is caring for a group of clients. Which of the following actions should the nurse take to prevent the spread of infection?

• A. Carry a client's soiled linens out of the room in a mesh linen bag
• B. Place a client who has tuberculosis in a room with negative-pressure airflow
• C. Provide disposable plates and utensils for a client who is HIV-positive
• D. Dispose of a client's blood-saturated dressing in a biohazard bag

Correct answer: B

Rationale: A client who has tuberculosis requires airborne precautions, including placing the client in a room with negative-pressure airflow to reduce the risk of infection transmission. Choices A, C, and D are incorrect. Carrying soiled linens in a mesh bag, providing disposable plates and utensils for an HIV-positive client, and disposing of blood-saturated dressing in a biohazard bag do not specifically address preventing the spread of tuberculosis, which requires airborne precautions.

3. A healthcare professional uses a head-to-toe approach to conduct a physical assessment of a client who will undergo surgery the following week. Which of the following critical thinking did the healthcare professional demonstrate?

• A. Confidence
• B. Perseverance
• C. Integrity
• D. Discipline

Correct answer: D

Rationale: The correct answer is 'Discipline.' In this scenario, discipline is exemplified by following a structured and comprehensive assessment process, as seen in the head-to-toe approach. Confidence (choice A) relates to self-assurance and belief in one's abilities, which is not the primary critical thinking demonstrated in this situation. Perseverance (choice B) is the persistence in achieving goals despite challenges, not directly related to the systematic assessment process. Integrity (choice C) pertains to honesty and ethical behavior, which are important traits but not the critical thinking skill exemplified by the structured assessment process shown in the head-to-toe approach.

4. A client expresses pain during dressing changes postoperatively. Which intervention should the nurse prioritize?

• A. Encourage the client to relax and take deep breaths during the dressing change.
• B. Educate the client about the importance of pain management postoperatively.
• C. Assist the client to a comfortable position for the dressing change.
• D. Administer pain medication 45 minutes before changing the client's dressing.

Correct answer: D

Rationale: The priority action for the nurse is to address the client's immediate physiological need for comfort and pain relief during the dressing change. Administering pain medication 45 minutes before the procedure can help alleviate the pain experienced by the client. Encouraging relaxation techniques (choice A) is beneficial but may not provide sufficient pain relief during the dressing change. Educating about the importance of pain management (choice B) is relevant but does not address the immediate need for pain relief. Assisting the client to a comfortable position (choice C) is helpful but does not directly address the client's pain concern during the dressing change. Administering pain medication is the most direct and effective intervention to ensure optimal client comfort and compliance with necessary procedures.

5. The client with diabetes is being educated by the nurse on foot care. Which statement by the client indicates a need for further teaching?

• A. I will check my feet daily for any cuts or sores.
• B. I will avoid walking barefoot.
• C. I will soak my feet in warm water every day.
• D. I will wear shoes that fit well to avoid blisters.

Correct answer: C

Rationale: The correct answer is C. Soaking the feet in warm water daily is not recommended for clients with diabetes as it can cause the skin to become too soft, increasing the risk of skin breakdown and infections. Checking the feet daily for cuts or sores (A) is a good practice to prevent complications. Avoiding walking barefoot (B) helps protect the feet from injuries. Wearing well-fitted shoes (D) is essential to prevent blisters and other foot problems in diabetic clients. Therefore, the client's statement about soaking the feet in warm water daily indicates a need for further teaching.

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