Nursing Elites

1. A client who is acutely ill has vigilant oral care included in their plan of care. What factor increases this client's risk for dental caries?

• A. Hormonal changes induced by the stress response leading to an acidic oral environment
• B. Systemic infections commonly affecting the teeth
• C. Intravenous hydration lacking fluoride
• D. Inadequate nutrition and reduced saliva production contributing to cavities

Correct answer: D

Rationale: Inadequate nutrition and decreased saliva production can lead to a conducive environment for the development of dental caries. Without proper nutrition and sufficient saliva, the protective mechanisms against cavities are compromised, making the individual more susceptible to tooth decay.

2. A client is being discharged with a new prescription for enoxaparin (Lovenox). Which instruction should the nurse include?

• A. Administer the injection in your thigh.
• B. Do not expel the air bubble from the syringe before injection.
• C. Massage the injection site after administration.
• D. Alternate the injection site between the arms.

Correct answer: B

Rationale: The correct instruction for a client with a prescription for enoxaparin (Lovenox) is not to expel the air bubble from the syringe before injection. This ensures the full dose is delivered without affecting the medication's efficacy. Expelling the air bubble may lead to a loss of medication, resulting in suboptimal treatment. Therefore, it is crucial for the client to follow this instruction to receive the intended therapeutic effect of enoxaparin.

3. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy. Which instruction should the nurse provide?

• A. Use oxygen continuously, even while sleeping.
• B. Adjust the oxygen flow rate to 5 liters per minute if short of breath.
• C. Report any signs of difficulty breathing immediately.
• D. Take off the oxygen while eating or drinking.

Correct answer: A

Rationale: The correct instruction for a client with COPD receiving oxygen therapy is to use oxygen continuously, even while sleeping. This is important to ensure adequate oxygenation and optimal respiratory function for clients with COPD. Continuous oxygen therapy helps maintain oxygen levels during sleep, which is crucial for individuals with COPD who may experience nighttime hypoxemia. Therefore, advising the client to use oxygen continuously, even during sleep, is essential in managing COPD and preventing complications associated with oxygen deprivation.

4. A 9-year-old female client was recently diagnosed with diabetes mellitus. Which symptom will her parents most likely report?

• A. Refuses to eat her favorite meals at home.
• B. Drinks more soft drinks than previously.
• C. Voids only one or two times per day.
• D. Gained 10 pounds within one month.

Correct answer: B

Rationale: The correct answer is B. Increased thirst and fluid intake, such as drinking more soft drinks than previously, is a common symptom of diabetes mellitus in children. This increased thirst is due to the body trying to eliminate excess sugar through urination, leading to dehydration and the need for more fluids. The other choices are less likely to be directly related to the diagnosis of diabetes mellitus in this scenario.

5. When should the charge nurse intervene based on the observed behavior?

• A. Two staff members are overheard talking about a cure for AIDS outside a client's room.
• B. A hospital transporter is reading a client's history and physical while waiting for an elevator.
• C. A UAP tells a client, 'It's hard to quit drinking but Alcoholics Anonymous helped me.'
• D. Two visitors are discussing a hospitalized client's history of drug abuse in the visitor's lounge.

Correct answer: B

Rationale: The hospital transporter reading a client's history and physical without a legitimate need violates patient confidentiality. This behavior requires immediate intervention to protect the client's privacy and confidentiality rights.

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